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

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

Thomas L Holland  1   2 , Arnold S Bayer  3   4 , Vance G Fowler  1   2
Affiliations

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

Thomas L Holland et al. Clin Infect Dis. .

Erratum in

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.

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Conflict of interest statement

Potential conflicts of interest. T. L. H. reports NIH grant UM1-AI104681 (Antibacterial Resistance Leadership Group), consulting fees from Basilea Pharmaceutica, Genentech, Motif Bio, and Aridis, and personal fees from Lysovant; participation on SNAP Trial Platform DSMB; and royalties from UpToDate. A. S. B. reports research grants from Roivant Pharmaceuticals, ContraFect Corp., and Akagera Medicines, Lysovant Pharmaceuticals, National Institutes of Health (NIAID), Cystic Fibrosis Foundation, and Department of Defense. V. G. F. reports personal fees from Novartis, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Basilea, Affinergy, Janssen, xBiotech, Contrafect, Regeneron, Basilea, Destiny, Amphliphi Biosciences. Integrated Biotherapeutics, C3J, Armata, Valanbio, Akagera, Aridis, and Roche; grants from NIH, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Contrafect; Karius; Genentech, Regeneron, Basilea, Janssen, from Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm, Royalties from UpToDate; supported by Contrafect to present Phase 2 data at 2019 ECCMID; is an Associate Editor for Clinical Infectious Diseases; stock or stock options from ArcBio and Valanbio; and a patent pending in sepsis diagnostics. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Potential pragmatic MRSA bacteremia trial designs. Abbreviations: CT, computed tomography; MRSAB, methicillin-resistant Staphylococcus aureus bacteremia; PET, positron emission tomography; TEE, transesophageal echocardiography.
Figure 2.
Figure 2.
Suggested management algorithm for MRSA bacteremia. Abbreviations: AUC, area under the curve; MIC, minimum inhibitory concentration; MRSAB, methicillin-resistant Staphylococcus aureus bacteremia.
See this image and copyright information in PMC

References

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