S. aureus bacteremia

General Information

Mortality rate is as high as 25%.
Mandatory consult to Infectious Disease.
S. aureus bacteremia often relapses after treatment, due to undiagnosed metastatic infection.

Empiric therapy until susceptibilities known

Vancomycin IV loading dose followed by maintenance for target trough of 15-20 ug/mL
see dosing nomogram

If patient cannot be dosed using nomogram
contact Pharmacy.

AND

Cloxacillin 2g IV q4h

OR

Cefazolin 2g IV q8h

Further Management

Repeat 2 sets blood cultures q48hrs until negative

Identify source of infection & potential metastatic complications.

Consider any indwelling medical device, skin and soft tissue infection, endocarditis, septic thrombophlebitis, osteomyelitis, septic arthritis, epidural abscess, pneumonia.

Remove intravascular catheters present at the time the bacteremia was found, and send tip for culture

Consult as appropriate for advice and/or consideration of removal of permanent devices.

Example: tunnelled lines, pacemakers, valves, graphs, prosthetic joints or other prosthetic material.