Reply to Robertson: True Staphylococcus aureus Bacteremia

Clinical Infectious Diseases, vol. 79, pp. 568–569

Abstract

To the Editor—We thank Dr Robertson for his interest in our recent article about the global management of Staphylococcus aureus bacteremia (SAB). He brings up an important issue about the definition of SAB and potential risk of overtreating patients without true bacteremia [1]. We agree with the importance of the accuracy of the diagnosis “bacteremia” and with the improvement of microbiological diagnostics over time. One aspect of the improvement is that the time to positivity (TTP) of blood cultures has been reduced substantially [2]. A short TTP has been associated with complicated SAB [3–5], and the combination of a long TTP, a single positive blood culture, and low clinical pretest probability may help in distinguishing contaminants. However, as Dr Robertson rightly mentioned, the price of errors in this context is high, and patients may be severely prejudiced when unjustly denied antibiotics [6]. Furthermore, the absence of a substantial decrease in mortality of S. aureus bacteremia over the past decades [7] does not suggest a significant increase in pseudo-bacteremia patients. Once again, we thank Dr Robertson for his reaction and for emphasizing once more the challenging management and consensus on definitions of this common disease.

Authors 3

1. Annette C. Westgeest corresponding Aachen Department of Infectious Diseases

   Leiden University Medical Center

   Affiliation as printed

   Department of Infectious Diseases, Leiden University Medical Center , Leiden , The Netherlands

2. Merel M. C. Lambregts Aachen Department of Infectious Diseases

   Leiden University Medical Center

   Affiliation as printed

   Department of Infectious Diseases, Leiden University Medical Center , Leiden , The Netherlands

3. Vance G. Fowler

   Duke University

   Affiliation as printed

   Department of Infectious Diseases, Duke University , Durham, North Carolina , USA