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Persistent Staphylococcus aureus bacteremia — ABIM Board MCQ

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HardInfectious DiseasePersistent Staphylococcus aureus bacteremiaABIM Board

A 58-year-old man has methicillin-susceptible Staphylococcus aureus bacteremia from an infected peripheral IV catheter. The catheter is removed, but blood cultures remain positive 72 hours after oxacillin is started. He has back pain and a new systolic murmur. Which of the following is the most appropriate management?

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Correct answer: A — Obtain transesophageal echocardiography and evaluate metastatic infection

Persistent S. aureus bacteremia is complicated bacteremia and requires repeat cultures, evaluation for endocarditis with TEE, assessment for metastatic foci, and prolonged IV therapy tailored to source and susceptibility.

Reference: IDSA MRSA Guideline; AHA Infective Endocarditis Scientific Statement