Staphylococcus Aureus Bacteremia (SAB) Name: RN:

Management Protocol
Date of 1st positive blood culture:_________ Organism: MSSA / MRSA First trough level should be done before 4th dose.
Date Vancomycin Trough level
Antibiotics dose (target 15-20 ug/ml)
MSSA   IV Cloxacillin 2gm 6 hourly (4 hourly if IE) OR
 IV Cefazolin 1gm 8 hourly (alternative)
MRSA   IV Vancomycin 15mg/kg 12 hourly (If patient is ill, LOAD with 25mg/kg)
*Dosage for normal renal function
Follow-up blood cultures
Vancomycin dose MUST be optimized to achieve
Date Blood culture result Day of anti-staph antibiotics
target level as soon as possible.

Repeat blood cultures after 48-72 hours of

treatment. Continue follow-up blood
cultures if previous blood culture positive.

Surveillance of metastatic infections TTE MUST be performed to rule out IE.

Consider TOE if:
Echocardiogram Date Result
 TTE inconclusive or poor imaging
(MANDATORY)  Prosthetic valve
 TTE  Congenital heart disease
 TOE  Persistent SAB despite ≥ 5 days of appropriate treatment.

Other imaging (Optional) Date Result

Look out for signs & symptoms:
 CXR
 Abdominal pain/tenderness
 Ultrasound abdomen  Unexplained raised liver enzymes
 CT scan  Joint pain/swelling, back pain or spinal tenderness
 MRI spine  Headache / focal neurological deficits
 Others:  Suspicious of lung abscess in CXR


Source control

Lines Site Date of insertion Infected / Thrombophlebitis Date of removal

(Yes / No)
 Branula
 Central line
 EVD

Metastatic infections Site Date of diagnosis Drainage / Debridement / Removal Date of op

 Abscess
 Septic arthritis
 IE (complicated)
 Implant / prosthesis

Duration of antibiotics**
 IE has been excluded Complicated
Uncomplicated  Follow-up blood cultures cleared after 48-72 hours of Rx SAB
SAB  Patient defervesced within 72 hours of Rx No ≥ 4- 6 weeks
2 weeks Yes  No evidence of metastatic infections
 No implant or prosthesis (Suggest consult ID for duration and
 Source of baceremia removed choice of antibiotics)

**IV antibiotics should be used in SAB.

SAB/July/2019