Clinical Management ofStaphylococcus aureusBacteremia

Abstract

Importance Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia (SAB). The strength of evidence supporting these management strategies, however, varies widely. Objective To perform a systematic review of the evidence for two unresolved questions involving management strategies for SAB: 1) is transesophageal echocardiography (TEE) necessary in all cases of SAB; and 2) what is the optimal antibiotic therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia? Evidence acquisition A PubMed search from inception through May 2014 was performed to find studies that addressed the role of TEE in SAB. A second search of PubMed, EMBASE, and The Cochrane Library from 1/1/1990 to 5/28/2014 was performed to find studies that addressed antibiotic treatment of MRSA bacteremia. Studies that reported outcomes of systemic antibiotic therapy for MRSA bacteremia were included. All searches were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the GRADE system by consensus of independent evaluations by at least two authors. Results In 9 studies with a total of 3513 patients, use of TEE was associated with higher rates of diagnosis of endocarditis (14–25%) when compared with TTE (2–14%). Five studies proposed criteria to identify patients in whom TEE might safely be avoided. Only one high-quality trial of antibiotic therapy for MRSA bacteremia was identified from the 83 studies considered. Conclusions and relevance Most contemporary management strategies for SAB are based upon low quality evidence. TEE is indicated in most patients with SAB. It may be possible to identify a subset of SAB patients for whom TEE can be safely avoided. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of SAB are desperately needed.

Synergistic antibacterial effects of herbal extracts and antibiotics on methicillin-resistant Staphylococcus aureus: A computational and experimental study

“…6 However, their effectiveness is declining. 5 Much evidence has shown that the increased resistance of vancomycin has led to poor therapeutic outcomes and increased patient mortality.…”

Infective Endocarditis

“…Patients with S. aureus bacteraemia should undergo echocardiography because of the high frequency of IE in this setting. TTE may be adequate in a carefully selected minority of patients who do not have a permanent intracardiac device, have sterile follow-up blood cultures within 4 days after the initial set, are not haemodialysis dependent, have nosocomial acquisition of bacteraemia, do not have secondary foci of infection and do not have clinical signs of IE 105 . To differentiate patients with S. aureus bacteraemia who are at high risk of IE from those at low risk, several scoring systems have been proposed [106][107][108][109][110] although none has been prospectively evaluated.…”

“…Antistaphylococcal β-lactam antibiotics are recommended whenever possible for MSSA-associated IE, as data from observational studies suggest worse outcomes for patients with MSSA bloodstream infections who are treated with vancomycin 105,139 . Whether it is necessary to use a β-lactam antibiotic as empiric therapy is unclear; small retrospective studies have suggested a potential benefit 140 .…”

An Audit of Staphylococcus aureus Bacteraemia Treatment in a UK District General Hospital

“…In 2014, in the UK alone, there were 9,100 cases of SAB reported in Public Health England's voluntary surveillance database, [4] care, and administering appropriate antibiotics for a sufficient length of time [1][2][3]5,6].…”