Persistent Methicilin-Resistant Staphylococcus aureus Bacteremia: Resetting the Clock for Optimal Management

Clin Infect Dis. 2022 Oct 29;75(9):1668-1674. doi: 10.1093/cid/ciac364.

Abstract

A positive follow-up blood culture for methicillin-resistant Staphylococcus aureus (MRSA) while on seemingly appropriate therapy is a common and ominous development. However, the definition and management of persistent MRSA bacteremia is unstandardized. In this Opinion Paper, we identify the presence of bacteremia for > 1 calendar day as a "worry point" that should trigger an intensive diagnostic evaluation to identify metastatic infection sites. Next, we define the duration of MRSA bacteremia that likely constitutes antibiotic failure and outline a potential management algorithm for such patients. Finally, we propose pragmatic clinical trial designs to test treatment strategies for persistent MRSA bacteremia.

Keywords: Staphylococcus aureus bacteremia; methicillin-resistance.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia* / diagnosis
  • Bacteremia* / drug therapy
  • Humans
  • Methicillin-Resistant Staphylococcus aureus*
  • Pragmatic Clinical Trials as Topic
  • Staphylococcal Infections* / diagnosis
  • Staphylococcal Infections* / drug therapy

Substances

  • Anti-Bacterial Agents