Staphylococcus aureus bacteremia
Staphylococcal bacteremia is one of the most common causes of acute deterioration of the health status of patients in internal medicine with very high mortality (about 30%). It always requires immediate hospitalization, carefully performed diagnostic algorithm and adequate antibiotic treatment. In our algorithm, you will try to solve one of the typical case reports associated with staphylococcal bacteremia.
Review
Staphylococcal bacteremia is a serious condition associated with high mortality and a risk of metastatic spread to distant organs. Staphylococcus aureus shows a pronounced affinity for myocardial and bone tissue, and consequently some patients with bacteremia develop secondary spondylodiscitis, which significantly complicates treatment and the further clinical course. The algorithm guides the user through the case of a specific patient, from the detection of a positive blood culture through identification of the source of infection to the management of this serious condition. Emphasis is placed on correctly obtaining repeated blood cultures and on early consultation with an infectious disease specialist. The user is guided toward indicating echocardiography to rule out infective endocarditis, which frequently accompanies Staphylococcus aureus bacteremia. The algorithm further addresses spinal magnetic resonance imaging as the gold standard for demonstrating spondylodiscitis and its complications. If the diagnosis remains unclear, a targeted sample may be taken from the affected site of the spine for microbiological testing before adjusting antibiotic therapy. The therapeutic section introduces the choice of targeted antibiotic therapy — an anti-staphylococcal penicillin — the question of switching to oral treatment, and the recommended duration of therapy. Surgical intervention and multidisciplinary collaboration are often required, in which the infectious disease specialist plays a key role as the coordinator of diagnostics, the choice and duration of antibiotic therapy, and monitoring of the entire disease course. The algorithm is thus a suitable educational tool not only for infectious disease specialists but for all specialties involved in the care of these patients.
Sources
MINTER, D. J.; APPA, A.; CHAMBERS, H. F.; DOERNBERG, S. B. Contemporary Management of Staphylococcus aureus Bacteremia – Controversies in Clinical Practice. Clinical Infectious Diseases. 2023, 77(11), e57–e68. Available from: https://doi.org/10.1093/cid/ciad500
LAM, J. C.; STOKES, W. The Golden Grapes of Wrath – Staphylococcus aureus Bacteremia: A Clinical Review. The American Journal of Medicine. 2023, 136(1), 19–26. Available from: https://doi.org/10.1016/j.amjmed.2022.09.017
LIU, C.; BAYER, A.; COSGROVE, S. E. et al. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive Summary. Clinical Infectious Diseases. 2011, 52(3), 285–292. Available from: https://doi.org/10.1093/cid/cir034
HOLLAND, T. L.; ARNOLD, C.; FOWLER, V. G., Jr. Clinical Management of Staphylococcus aureus Bacteremia: A Review. JAMA. 2014, 312(13), 1330–1341. Available from: https://doi.org/10.1001/jama.2014.9743
Learning targets
2. The student can propose a diagnostic algorithm and properly manage SAB therapy
3. The student can distinguish between complicated and uncomplicated SAB and can infer differences in treatment duration
Key points
2. SAB is a life-threatening condition that requires properly managed and specific treatment
3. The minimum duration of adequate anti-staphylococcal antibiotic therapy for SAB is 14 days, and, in certaint cases (endocarditis, osteomyelitis, abscesses, infected thrombosis...), the treatment is longer (4 weeks or more). Active screening for infection sites in the body is necessary to determine the proper length of therapy.
