Six aspects of clinical management from 16 articles showing an impact on outcome were selected as QCIs (Table 2): performance of follow-up blood cultures; early source control; performance of echocardiography in patients with specific criteria; early use of intravenous cloxacillin in cases of methicillin-susceptible S. aureus (MSSA) (or cefazolin in patients under hemodialysis) as definitive therapy in nonallergic patients; adjustment of vancomycin dose according to trough levels; and provision of an appropriate duration of therapy according to the complexity of infection.
This confirms that treatment of staph aureus bacteremia is complex and multifaceted, and that adherence to several care processes is important for a good outcome. That is why ID consultation has been demonstrated to produce better outcomes as I noted back in 2009. From that post:
So if ID consultation really is producing better outcomes what are the ID docs adding? From the descriptions above, better evaluation and management all the way around, it would appear. Based on the descriptions above, if ID consultation is not readily available at your hospital, be aware of the modalities often overlooked by non-specialists: knowing when vanco is not enough; getting follow up blood cultures; source control; treating long enough; appropriate use of imaging to diagnose endocarditis and other complications; switching to a beta lactam antibiotic if the organism turns out to be MSSA.