Staphylococcus aureus bacteremia: Difference between revisions
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Staphylococcus aureus bacteremia
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* '''Community-onset:''' positive blood culture obtained within 48 hours of presentation |
* '''Community-onset:''' positive blood culture obtained within 48 hours of presentation |
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* '''Nosocomial:''' positive blood culture obtained after 48 hours of presentation |
* '''Nosocomial:''' positive blood culture obtained after 48 hours of presentation |
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− | + | = Etiology = |
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* IVDU |
* IVDU |
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* Dental work |
* Dental work |
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− | + | = Clinical Presentation = |
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* Often non-specific fevers and chills, diagnosed on blood cultures |
* Often non-specific fevers and chills, diagnosed on blood cultures |
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* May present with focus of metastatic disease |
* May present with focus of metastatic disease |
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− | + | = Investigations = |
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− | + | = Management = |
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* Infectious diseases consultation |
* Infectious diseases consultation |
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** Target trough 15-20 |
** Target trough 15-20 |
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− | + | = Prognosis = |
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* Mortality 20-50% at 30 days, 60% at 1 year |
* Mortality 20-50% at 30 days, 60% at 1 year |
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** Institutionalized patient |
** Institutionalized patient |
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− | + | = Further Reading = |
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+ | [[Category:Bacteremia]] |
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+ | [[Category:Staph. aureus]] |
Revision as of 16:16, 13 August 2019
Definition
- Community-onset: positive blood culture obtained within 48 hours of presentation
- Nosocomial: positive blood culture obtained after 48 hours of presentation
Etiology
- IVDU
- Poor dentition
- Dental work
Clinical Presentation
- Often non-specific fevers and chills, diagnosed on blood cultures
- May have back pain unrelated to spinal osteomyelitis
- May present with focus of metastatic disease
Investigations
Management
- Infectious diseases consultation
- Must rule out endocarditis! TTE, followed by TEE if suspicion remains high
- Low risk for endocarditis (no TEE) if all of the following:
- No intracardiac device
- Sterile follow-up blood cultures within 4 days from the initial set
- No hemodialysis
- Nosocomial acquisition of S. aureus
- Absence of secondary foci
- No clinical signs of endocarditis
- Uncomplicated if
- Endocarditis is excluded
- No implanted prostheses
- Blood cultures clear by 2-4 days
- Defervesces within 72 hours
- No evidence of metastases
- +/- identified source has been removed
- Two-week course acceptable if uncomplicated, otherwise 4-6 weeks
- MSSA: cloxacillin 2g IV q4h for 2 weeks (cefazolin as an alternative)
- MRSA: vancomycin 1g IV q12h for 2 weeks
- Adjust based on serum trough before every fourth dose
- Target trough 15-20
Prognosis
- Mortality 20-50% at 30 days, 60% at 1 year
- Mortality halved by ID consult
- Prognosis worse with
- Increased age
- Female sex
- Pneumonia or source unknown
- Dementia
- Increasing comorbidities
- Shock at time of presentation
- Institutionalized patient