Clinical Management of Staphylococcus aureus Bacteremia A Review

被引:358
作者
Holland, Thomas L. [1 ,2 ]
Arnold, Christopher [1 ]
Fowler, Vance G., Jr. [1 ,2 ]
机构
[1] Duke Univ, Sch Med, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA
[2] Duke Univ, Duke Clin Res Inst, Durham, NC 27710 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2014年 / 312卷 / 13期
基金
美国国家卫生研究院;
关键词
INFECTIOUS-DISEASES CONSULTATION; BLOOD-STREAM INFECTION; MINIMUM INHIBITORY CONCENTRATION; GRAM-POSITIVE INFECTIONS; INTRAVENOUS-DRUG-USERS; SOFT-TISSUE INFECTIONS; HIGH-DOSE DAPTOMYCIN; METHICILLIN-RESISTANT; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; STANDARD THERAPY;
D O I
10.1001/jama.2014.9743
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia. OBJECTIVES To review evidence of management strategies for S aureus bacteremia to determine whether transesophageal echocardiography is necessary in all adult cases and what is the optimal antibiotic therapy for methicillin-resistant S aureus (MRSA) bacteremia. EVIDENCE REVIEW A PubMed search from inception through May 2014 was performed to identify studies addressing the role of transesophageal echocardiography in S aureus bacteremia. A second search of PubMed, EMBASE, and the Cochrane Library from January 1990 through May 2014 was performed to find studies addressing antibiotic treatment for MRSA bacteremia. Studies reporting outcomes from antibiotic therapy for MRSA bacteremia were included. All searches, which were limited to English and focused on adults, were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation system with consensus of independent evaluations by at least 2 of the authors. FINDINGS In 9 studies with a total of 4050 patients, use of transesophageal echocardiography was associated with higher rates of a diagnosis of endocarditis (14%-28%) compared with transthoracic echocardiography (2%-15%). In 4 studies, clinical or transthoracic echocardiography findings did not predict subsequent transesophageal echocardiography findings of endocarditis. Five studies identified clinical or transthoracic echocardiography characteristics associated with low risk of endocarditis (negative predictive values from 93% to 100%). Characteristics associated with a low risk of endocarditis include absence of a permanent intracardiac device, sterile follow-up blood cultures within 4 days after the initial set, no hemodialysis dependence, nosocomial acquisition of S aureus bacteremia, absence of secondary foci of infection, and no clinical signs of infective endocarditis. Of 81 studies of antibiotic therapy for MRSA bacteremia, only 1 high-quality trial was identified. In that study of 246 patients with S aureus bacteremia, daptomycin was not inferior to vancomycin or an antistaphylococcal penicillin, each in combination with low-dose, short-course gentamicin (clinical success rate, 44.2%[53/120] vs 41.7%[48/115]; absolute difference, 2.4%[95% CI, -10.2% to 15.1%]). CONCLUSIONS AND RELEVANCE All adult patients with S aureus bacteremia should undergo echocardiography. Characteristics of low-risk patients with S aureus bacteremia for whom transesophageal echocardiography can be safely avoided have been identified. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of S aureus bacteremia are needed. Copyright 2014 American Medical Association. All rights reserved.
引用
收藏
页码:1330 / 1341
页数:12
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