Staph Aureus Bacteremia

    Table of contents

    . based on talk by Dr. Paul Bunce.

    Staph Aureus Bactermia

    • Mortality ~ 90-100% without treatment
      • 30-40% with treatment.
    • High risk of complications.
    • Diagnosis:
      • Blood cultures x 2 (Two different sites - preferrably ~10-20min apart)
      • Take one more prior to starting abx. 
    • Source:
      • Skinsaa.jpg
      • Abscess
      • Line
      • Wound
      • Urine
    • Focus
      • Endocarditis
      • Prosthetic Devices
        • Devices
        • Hardware
      • Osteomyelitis / Discitis
      • CNS
      • Abscess
        • Spleen
        • Liver
        • Psoas
      • Joints
    • Management
    1. ABC's
    2. Abx
      • Cloxacillin 2g IV q4h  (Good starting antibiotic, more effective at killing, not effective for MRSA)
      • Vancomycin minimal 2w IV --> 6w   (Effective for MRSA, not as effective as clox)
    3. Source control
      • Remove lines until blood sterile.  (if must keep, replace the line)
    4. Find the focus
      • Hx + Physical
      • Tests
        • Trans Thoracic Echo (less sensitivity)
        • Trans-Esophageal Echo (more sensitivity)
      • Risk factors for SBE:
        • Prolongued bactermia 48-72h
        • Prolongued fever 2-3d.
        • Stigmata of endocarditis (Conjunctival hemorrhages, Olser nodes, Janeway lesions, splinter hemorrhages, etc..)
        • Community vs. Hospital Acquired (Community - worse)
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