Medical Care

Promptly start antimicrobial therapy when S aureus infection is documented or strongly suspected. Appropriate choices depend on local susceptibility patterns.^[3]Initiation of subinhibitory concentrations of antibiotics may lead to increased production of PVL.^[34]The Infectious Diseases Society of America (IDSA) has published detailed guidelines on the treatment of methicillin-resistant S aureus (MRSA) infections.^[35]

Patients are defined as having uncomplicated MRSA bacteremia if endocarditis has been excluded; there are no implanted prostheses; follow-up blood cultures performed on specimens obtained 2 to 4 days after the initial positive set do not grow MRSA; defervescence occurs within 72 hours of initiating effective therapy; and there is no evidence of metastatic sites of infection. Such patients can be treated for 14 days with a low relapse/failure rate.^{[35, 36]}

Temporary intravascular devices should be promptly removed if infection is suspected.^[4]Long-term intravascular devices should be removed if infection with S aureus is documented.

Multiple decolonization regimens have been used in patients with recurrent staphylococcal infection. Treatment with topical mupirocin, chlorhexidine gluconate washes, and oral rifampin plus doxycycline for 7 days eradicated MRSA colonization in hospitalized patients.^[5]Household members should avoid sharing personal hygiene items; decolonization of all household members should be recommended to patients with recurrent skin and soft tissue infections or to patients with multiple household members who experience skin and soft tissue infections.^[37]

Surgical Care

Abscesses must be drained. Infections involving a prosthetic joint usually require removal of the prosthesis. Other infections involving a prosthetic device, such as a prosthetic heart valve or implanted intravascular device, may or may not require removal of the device.

Consultations

Consultation with an infectious disease specialist should be obtained for all patients with S aureus bacteremia. Doing so results in improved adherence to IDSA guidelines, decreased in-hospital mortality, and earlier discharge.^[38]Pharmacist intervention through vancomycin dosing has been shown to improve survival rates in a retrospective study of patients with MRSA bacteremia.^[6]

Medication

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Media Gallery

Embolic lesions in patient with Staphylococcus aureus endocarditis.
Close-up view of embolic lesions in patient with Staphylococcus aureus endocarditis.
Fifty-six-year-old man with erythema, edema, and drainage from below his right eye.
Gram stain in a 70-year-old woman with rheumatoid arthritis.