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S. aureus Bacteraemia — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsS. aureus BacteraemiaSCE Infectious Diseases

A 70-year-old woman with a permanent pacemaker is admitted with Staphylococcus aureus bacteraemia. TOE is negative for vegetation. CT shows no distant foci. Blood cultures clear within 48 hours. She declines device extraction. What is the minimum antibiotic duration?

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Correct answer: E — 6 weeks of IV anti-staphylococcal therapy if device is retained

When a CIED is present and S. aureus bacteraemia occurs, device-related infection must be assumed until proven otherwise. If device extraction is declined or not feasible, a prolonged course of IV antibiotics (minimum 6 weeks) is recommended, followed by consideration of long-term oral suppressive therapy. The AHA 2024 scientific statement emphasises that without extraction, relapse rates are high. This differs from uncomplicated SAB without hardware (minimum 14 days).

Reference: AHA 2024 – CIED infection; BSAC 2023 – S. aureus bacteraemia guidelines