What is the treatment of S aureus bacteremia in infective endocarditis (IE)?

Updated: Jan 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Although resorting immediately to TEE is becoming more common, it is often unnecessary. A scoring system has been developed to help differentiate patients with valvular infection from those with S aureus bacteremia that represents metastatic infection from sites such as splenic abscesses or osteomyelitis. Individuals with an underlying implantable cardiac device or whose S aureus bloodstream infections developed in the community are at highest risk of IE and so should undergo immediate TEE. If the TEE findings are negative, it should be repeated in 5 days. [89]

It is important to recognize that, in up to one third of cases, a cause of persistent BSI is not identified. A good deal of these may be explained by endotheliosis. For the time being, the duration of antibiotic therapy for each case of S aureus catheter-related BSI must be individualized. The author and others would treat cases that meet the criteria of continuous bacteremia for a total of 4 weeks despite a negative TEE result. [90, 91, 92]


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