An 82-year-old man with non-Hodgkin’s lymphoma in remission and a history of congestive heart failure and hypertension presents with one week of generalized malaise and intermittent fevers. Vitals show a temperature of 101oF, blood pressure of 130/60 mmHg, and heart rate of 100. His exam is notable for an erythematous and tender chest port site, with no murmurs. Blood cultures drawn upon presentation show gram-positive cocci speciated to Staphylococcus aureus. What are the next steps in management of this patient?
Explore this issue:February 2013
S. aureus bacteremia (SAB) is a common infectious cause of morbidity and mortality worldwide, causing both community-acquired and hospital-acquired bacteremia. In the U.S. alone, it accounts for 23% of all bloodstream infections and is the bacterial pathogen most strongly associated with death.1 Mortality rates are approximately 42% in those with methicillin-resistant S. aureus (MRSA) bacteremia and 28% in those with methicillin-sensitive S. aureus (MSSA) bacteremia.2
Recognizing the severity of SAB, the Infectious Disease Society of America (IDSA) published treatment guidelines in 2011 to help direct the clinical care of this disease process.3 However, the majority of the recommendations are based on observational studies and expert opinion, as less than 1,500 patients have been enrolled in randomized controlled trials specifically targeted to investigate the treatment of SAB.4
Review of the Data
A clinically significant SAB usually is defined as the isolation of S. aureus from a venous blood culture with associated symptoms and signs of systemic infection.5 As SAB contamination is rare and can be associated with multiple complications, including metastatic infections, embolic stroke, recurrent infection, and death, any finding of a positive blood culture must be taken seriously.4