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Staphylococcus aureus Bacteremia

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General Information

General InformationGeneral Information

Description

  • bloodstream infection with Staphylococcus aureus1,2,3

Types

  • definitions vary among experts but common features include1,3
    • uncomplicated Staphylococcus aureus bacteremia
      • defervescence within 72 hours
      • clearance of bloodstream infection within 72 hours (demonstrated by culture)
      • no distal or metastatic focus of infection
      • absence or removal of intravascular hardware
      • no evidence of endocarditis by transesophageal echocardiography
      • no evidence of suppurative thrombophlebitis
      • removal of catheter in patients with catheter-associated infection
      • patient without active malignancy or immunosuppression
    • complicated S. aureus bacteremia
      • patient meets Duke criteria for possible or definite endocarditis
      • evidence of endocarditis
      • deep source of infection other than endocarditis (such as osteomyelitis or prosthetic joint infection)
      • persistently positive blood culture
      • patient with immunocompromise
      • failure to meet any criteria of uncomplicated bacteremia

References

General references used

  1. Thwaites GE, Edgeworth JD, Gkrania-Klotsas E, et al; UK Clinical Infection Research Group. Clinical management of Staphylococcus aureus bacteraemia. Lancet Infect Dis. 2011 Mar;11(3):208-22OpenInNew
  2. Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998 Aug 20;339(8):520-32OpenInNew, commentary can be found in N Engl J Med 1998 Dec 31;339(27):2026OpenInNew
  3. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1;49(1):1-45OpenInNewfull-textOpenInNew, corrections can be found in Clin Infect Dis 2010 Feb 1;50(3):457 and Clin Infect Dis 2010 Apr 1;50(7):1079, commentary can be found in Am J Kidney Dis 2009 Jul;54(1):13OpenInNew and Clin Infect Dis 2009 Dec 1;49(11):1770OpenInNew
  4. Liu C, Bayer A, Cosgrove SE, et al; Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55OpenInNewfull-textOpenInNew, corrections can be found in Clin Infect Dis 2011 Aug 1;53(3):319 , commentary can be found in Clin Infect Dis 2011 Jun 15;52(12):1468OpenInNew, Clin Infect Dis 2011 Jul 1;53(1):97OpenInNew, Clin Infect Dis 2011 Aug 1;53(3):308OpenInNew, Clin Infect Dis 2015 Apr 15;60(8):1290OpenInNew
  5. Rongpharpi SR, Duggal S, Kalita H, Duggal AK. Staphylococcus aureus bacteremia: targeting the source. Postgrad Med. 2014 Sep;126(5):167-75OpenInNew

Recommendation grading systems used

  • Infectious Diseases Society of America (IDSA) grades of recommendation
    • strength of recommendations
      • Grade A - good evidence to support a recommendation for or against use
      • Grade B - moderate evidence to support a recommendation for or against use
      • Grade C - poor evidence to support a recommendation
    • quality of evidence
      • Level I - evidence from > 1 properly randomized, controlled trial
      • Level II - evidence from > 1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from > 1 center); from multiple time series; or from dramatic results from uncontrolled experiments
      • Level III - evidence from opinions of authorities, based on clinical experience, descriptive studies, or reports of expert committees
  • American Heart Association/American College of Cardiology (AHA/ACC) grading system for recommendations
    • classifications of recommendations
      • Class I - procedure or treatment should be performed or administered
      • Class IIa - reasonable to perform procedure or administer treatment, but additional studies with focused objectives needed
      • Class IIb - procedure or treatment may be considered; additional studies with broad objectives needed, additional registry data would be useful
      • Class III - procedure or treatment should not be performed or administered because it is not helpful or may be harmful
        • Class III ratings may be subclassified as Class III No Benefit or Class III Harm
    • levels of evidence
      • Level A - data derived from multiple randomized clinical trials or meta-analyses
      • Level B - data derived from single randomized trial or nonrandomized studies
      • Level C - only expert opinion, case studies, or standard of care
  • European Society of Cardiology (ESC) grading system for recommendations
    • classifications of recommendations
      • Class I - procedure or treatment should be performed or administered
      • Class IIa - reasonable to perform procedure or administer treatment, but additional studies with focused objectives needed
      • Class IIb - procedure or treatment may be considered; additional studies with broad objectives needed, additional registry data would be useful
      • Class III - procedure or treatment should not be performed or administered because it is not helpful or may be harmful
        • Class III ratings may be subclassified as Class III No Benefit or Class III Harm
    • levels of evidence
      • Level A - data derived from multiple randomized clinical trials or meta-analyses
      • Level B - data derived from single randomized trial or nonrandomized studies
      • Level C - only expert opinion, case studies, or standard of care
    • Reference - European Society of Cardiology (ESC) guideline on prevention, diagnosis, and treatment of infective endocarditis can be found in 19713420Eur Heart J 2009 Oct;30(19):2369OpenInNewfull-textOpenInNew
  • American College of Radiology (ACR) rating scale
    • Rating 1, 2, and 3 - usually not appropriate
    • Rating 4, 5, and 6 - may be appropriate
    • Rating 7, 8, and 9 - usually appropriate

Synthesized Recommendation Grading System for DynaMed

  • DynaMed systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based MethodologyOpenInNew).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow DynaMed users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed (DM), we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE)OpenInNew to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed (DM) synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
    • Recommendations are initially drafted by clinical editors (including ≥ 1 with methodological expertise and ≥ 1 with content domain expertise) aware of the best current evidence for benefits and harms, and the recommendations from guidelines.
    • Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing.
    • Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed-initiated groups:
      • Clinical questions will be formulated using the PICO (Population, Intervention, Comparison, Outcome) framework for all outcomes of interest specific to the recommendation to be developed.
      • Systematic searches will be conducted for any clinical questions where systematic searches were not already completed through DynaMed content development.
      • Evidence will be summarized for recommendation panel review including for each outcome, the relative importance of the outcome, the estimated effects comparing intervention and comparison, the sample size, and the overall quality rating for the body of evidence.
      • Recommendation panel members will be selected to include at least 3 members that together have sufficient clinical expertise for the subject(s) pertinent to the recommendation, methodological expertise for the evidence being considered, and experience with guideline development.
      • All recommendation panel members must disclose any potential conflicts of interest (professional, intellectual, and financial), and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
      • All steps in this process (including evidence summaries which were shared with the panel, and identification of panel members) will be transparent and accessible in support of the recommendation.
    • Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
    • Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
    • If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details.
    • If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.

DynaMed Editorial Process

Special acknowledgements

  • Sanjat Kanjilal, MD, MS, MPH (Research Fellow of Infectious Diseases, Harvard Medical School; Massachusetts General Hospital; Massachusetts, United States)
  • Dr. Kanjilal has declared that he has no financial conflicts of interest.
  • Zbys Fedorowicz, MSc, DPH, BDS, LDSRCS (Director of Bahrain Branch of the United Kingdom Cochrane Center, The Cochrane Collaboration; Awali, Bahrain)
  • Dr. Fedorowicz declares no relevant financial conflicts of interest.
  • Alan Ehrlich, MD, FAAFP (Executive Editor; Associate Professor of Family Medicine, University of Massachusetts Medical School; Massachusetts, United States)
  • Dr. Ehrlich declares no relevant financial conflicts of interest.
  • Choosing Wisely Canada acknowledges dissemination of their recommendations through DynaMed Plus to reach the point of clinical decision-making.
  • The Association of Medical Microbiology and Infectious Disease Canada provides review for the incorporation of Choosing Wisely Canada recommendations.
  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of DynaMed Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T905775, Staphylococcus aureus Bacteremia; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T905775. Registration and login required.
  • KeyboardArrowRight

    Overview and Recommendations

    • Background

    • Evaluation

    • Management

  • Related Summaries

  • KeyboardArrowRight

    General Information

    • Description

    • Types

  • KeyboardArrowRight

    Epidemiology

    • Incidence/Prevalence

    • Risk factors

  • KeyboardArrowRight

    Etiology and Pathogenesis

    • Causes

    • Pathogen

    • Pathogenesis

  • KeyboardArrowRight

    History and Physical

    • Chief concern

    • History

    • KeyboardArrowRight

      Physical

      • General physical

      • HEENT:

      • Cardiac

      • Abdomen

      • Musculoskeletal

      • Extremities

      • Neuro

  • KeyboardArrowRight

    Diagnosis

    • Making the diagnosis

    • Differential diagnosis

    • Testing overview

    • Blood tests

    • KeyboardArrowRight

      Echocardiography

      • Recommendations on echocardiography

      • Evidence supporting use of echocardiography

  • KeyboardArrowRight

    Treatment

    • Treatment overview

    • Recommendations

    • KeyboardArrowRight

      Medications

      • Drug options and dosages

      • Penicillin-sensitive Staphylococcus aureus infections

      • KeyboardArrowRight

        Methicillin-sensitive Staphylococcus aureus infections

        • Comparative efficacy of vancomycin and beta-lactam antibiotics

        • Comparative efficacy of beta-lactam antibiotics

      • KeyboardArrowRight

        Methicillin-resistant Staphylococcus aureus (MRSA) infections

        • First-line regimens

        • Ceftaroline regimens

      • Adjunctive antibiotics

      • Duration of antibiotic therapy

      • Persistent bacteremia/vancomycin treatment failure and salvage regimens

    • Source control

    • Consultation and referral

  • KeyboardArrowRight

    Complications and Prognosis

    • Complications

    • KeyboardArrowRight

      Prognosis

      • Mortality

      • Risk of complications

  • KeyboardArrowRight

    Prevention and Screening

    • Prevention

  • KeyboardArrowRight

    Quality Improvement

    • Physician Quality Reporting System Quality Measures

    • Choosing Wisely Canada

  • KeyboardArrowRight

    Guidelines and Resources

    • Guidelines

    • Review articles

    • MEDLINE search

  • Patient Information

  • KeyboardArrowRight

    ICD Codes

    • ICD-10 codes

  • KeyboardArrowRight

    References

    • General references used

    • Recommendation grading systems used

    • Synthesized Recommendation Grading System for DynaMed

    • DynaMed Editorial Process

    • Special acknowledgements

    • How to cite

Topic Editor
Sanjat Kanjilal MD, MS, MPH
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Affiliations

Research Fellow of Infectious Diseases, Harvard Medical School; Massachusetts, United States

Conflicts of Interest

Dr. Kanjilal has declared that he has no financial conflicts of interest.

Recommendations Editor
Zbys Fedorowicz MSc, DPH, BDS, LDSRCS
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Affiliations

Director of Bahrain Branch of the United Kingdom Cochrane Center, The Cochrane Collaboration; Awali, Bahrain

Conflicts of Interest

Dr. Fedorowicz declares no relevant financial conflicts of interest.

Deputy Editor
Alan Ehrlich MD, FAAFP
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Affiliations

Executive Editor, DynaMed; Associate Professor of Family Medicine, University of Massachusetts Medical School; Massachusetts, United States

Conflicts of Interest

Dr. Ehrlich declares no relevant financial conflicts of interest.

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