Synopsis
Treat every credible Staphylococcus aureus bloodstream isolate as clinically important, document rapid culture clearance, control the source and distinguish genuinely uncomplicated disease from endocardial or metastatic infection.
- Treat every credible S aureus blood-culture episode as true bacteraemia until a complete assessment proves otherwise.
- Repeat peripheral blood cultures every 24 to 48 hours until documented clearance; the clearance date helps define duration.
- Examine skin, wounds, vascular access, heart, spine, joints, neurological system and every implanted prosthesis for source and spread.
Key red flags
Staphylococcus aureus in a correctly collected blood culture is not dismissed as contamination.
Fever, rigors, hypotension, confusion or organ dysfunction may accompany any source and requires immediate active intravenous treatment.
Investigation priorities
Document sterilisation, detect persistent bacteraemia and establish the clearance date.
Management branches
A laboratory reports S aureus from blood or Gram-positive cocci strongly suggest it in an unwell patient.
- Contact the treating team urgently, use ABCDE and ensure an active intravenous regimen is prescribed with allergy and renal status documented.
- Obtain repeat peripheral cultures before the next dose when feasible without delaying urgent therapy.
Key medicines
Flucloxacillin for MSSA bacteraemiaGive 2 g intravenously every four hours in adults with methicillin-susceptible Staphylococcus aureus bacteraemia when beta-lactam therapy is safe.
Vancomycin for MRSAUse the local intravenous loading dose based on actual body weight followed by renal-adjusted maintenance and measured serum exposure.