Staphylococcus aureus in a blood culture is never a contaminant to be dismissed on one bottle. The management elements with the most consistent evidence are simple and often missed.
Repeat blood cultures every 24 to 48 hours until negative, because the day they clear sets the treatment clock. Arrange echocardiography, with a low threshold for transoesophageal imaging. Remove or replace infected lines and look for a drainable source. And ask for an infectious diseases consultation, which has been associated with lower mortality in observational studies.
- Repeat blood cultures until negative; count duration from the first negative
- Echocardiography for every patient; TOE if high risk or persistent bacteraemia
- Remove intravascular devices and drain collections
- Involve infectious diseases early
- Use a beta-lactam for MSSA rather than vancomycin
Why it matters
Shortened endocarditis courses only work when the underlying bacteraemia has been managed thoroughly first.
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