Approach to managing staphylococcal endocarditis

Baddour, 2015Habib, 2015

Staphylococcus aureus is the most common cause of native and prosthetic valve infective endocarditis in developed countries. Endocarditis caused by S. aureus often displays a more aggressive course compared with other common causes of endocarditis. It is associated with increased rates of embolism and stroke, a prolonged duration of bacteraemia and a higher mortality (particularly in prosthetic valve endocarditis)Baddour, 2015Habib, 2015Tong, 2015. Cardiac surgery may be required urgently, early in the course of the disease.

Coagulase-negative staphylococci are an important cause of prosthetic valve endocarditis, particularly in the first year after insertion of the valve. Coagulase-negative staphylococci are becoming a more common cause of native valve endocarditis and, if healthcare-associated, can display complex resistance patterns in some institutionsLee, 2018. Staphylococcus lugdunensis, a coagulase-negative staphylococci, has similar pathogenicity to S. aureus and requires similar management.

Management of staphylococcal endocarditis should involve a multidisciplinary team-based approach – see Approach to managing infective endocarditis. Close monitoring is essential, including repeat blood culture to confirm clearance of bacteraemia – see also Assessing and monitoring patients with Staphylococcus aureus bacteraemia.

The choice of antibiotic therapy for staphylococcal endocarditis depends on whether the pathogen is methicillin-susceptible or -resistant, not whether it is a coagulase-negative staphylococcus or S. aureus. Coagulase-negative staphylococci are often methicillin-resistant.

Do not use clindamycin, lincomycin or teicoplanin for staphylococcal endocarditis because rates of treatment failure with these drugs are unacceptably high.

For principles of antimicrobial therapy for infective endocarditis (including duration of therapy following valve surgery and considerations for ambulatory antimicrobial therapy), see Principles of antimicrobial therapy for infective endocarditis.

The following empirical regimens for staphylococcal endocarditis are included in this topic:

For additional considerations in people who inject drugs, see Native and prosthetic valve endocarditis caused by staphylococci in people who inject drugs.