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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. [ABSTRACT FROM AUTHOR]

The article discusses a study on the safety and efficacy of preoperative vaccination in the prevention of serious postoperative Staphylococcus aureus infection in patients undergoing cardiothoracic surgery. It describes the testing of a novel vaccine candidate (V710) containing a highly conserved S. aureus iron surface determinant B, which is shown to be immunogenic and well tolerated in the study's volunteers. Termination of the study was recommended by the independent data monitoring committee due to low efficacy and safety concerns.

The article describes the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with focus on its health care association. The researchers determined the clinical profile of hospitalized patients with CDIE, including advanced patient age, causation by staphylococci and high prevalence of health care-associated infection. Results revealed the co-existence of valve involvement in 66 patients, predominantly concomitant tricuspid valve infection with associated higher mortality. In-hospital mortality rates were higher than one-year mortality rates, while cardiac device removal showed a survival benefit of one year during the initial hospitalization based on proportional hazards regression analysis.

The article presents a medical research study that examined infection of a heart valve prosthesis, or prosthetic valve endocarditis (PVE), as a result of heart valve replacement surgery. The study examined the prevalence, clinical characteristics, and outcome of PVE, focusing on infections related to medical care. The authors state that the bacterium staphylococcus aureus is the leading cause of PVE. The authors concluded that health care-associated infection influences the outcome and characteristics of PVE and that complications of PVE strongly predict in-hospital mortality.

The article describes the case of a 50-year-old man who presented for evaluation of a desquamating rash on his face that had spread to other parts of his body. The patient had a history of metastatic mucinous appendiceal adenocarcinoma. He had taken multiple rounds of oral fluconazole, topical antibiotic ointment and intravenous antibiotics. He was diagnosed with acquired acrodermatitis enteropathica and underwent zinc supplementation but later died.

A response to letters to the editor is presented regarding a study by Fowler and colleagues on the global emergence of infective endocarditis caused by Staphylococcus aureus.