Staphylococcus aureus in a blood culture is never a contaminant. Management rests on a few steps that change outcome.
Repeat blood cultures every 24 to 48 hours until negative; the date of the first negative culture sets the treatment clock. Arrange echocardiography in every case, moving to transoesophageal imaging when the risk of endocarditis is higher, such as persistent bacteraemia, a prosthetic valve or device, or injection drug use. Remove infected lines.
Uncomplicated bacteraemia, meaning negative repeat cultures within 72 hours, no endocarditis or implanted device, and defervescence, is usually treated for at least 14 days intravenously. Anything else is complicated and needs longer. Infectious diseases consultation reduces mortality.
- Repeat blood cultures until negative and date treatment from the first negative set
- Arrange echocardiography for every patient with S aureus bacteraemia
- Remove any implicated intravenous line
- Request an infectious diseases consultation for every case
Why it matters
Duration decisions, including any future move to shorter courses, depend on knowing when the bacteraemia cleared.
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