Navigating the Challenges in Staphylococcus aureus Bloodstream Infection: A Practical Guide to Management

Hadar Mudrik-Zohar; Sean W X Ong; Todd C Lee; Steven Y C Tong

doi:10.1016/j.idc.2025.11.002

Navigating the Challenges in Staphylococcus aureus Bloodstream Infection: A Practical Guide to Management

Infect Dis Clin North Am. 2025 Dec 2:S0891-5520(25)00096-0. doi: 10.1016/j.idc.2025.11.002. Online ahead of print.

Authors

Hadar Mudrik-Zohar¹, Sean W X Ong², Todd C Lee³, Steven Y C Tong⁴

Affiliations

¹ Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. Electronic address: hadar.mudrikzohar@unimelb.edu.au.
² Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada. Electronic address: https://twitter.com/seanongwx.
³ Division of Infectious Diseases, Department of Medicine, McGill University, 1001 Decarie Boulevard E5-1820, Montreal, Quebec, H4A3S1, Canada. Electronic address: https://twitter.com/DrToddLee.
⁴ Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. Electronic address: https://twitter.com/syctong.

PMID: 41339173
DOI: 10.1016/j.idc.2025.11.002

Abstract

Staphylococcus aureus bacteremia (SAB) continues to challenge clinicians with its' diverse clinical presentations, risk of complications, and high mortality rate. While foundational principles of management, such as adequate source control and appropriate antibiotic treatment, remain unchanged, the landscape is evolving for both diagnostic and treatment strategies. This review explores emerging evidence; outlines current best practice in diagnosis, risk stratification, and treatment; and highlights ongoing controversies and limitations of traditional management paradigms. Given the marked clinical heterogeneity of SAB, advancing toward a personalized medicine approach that tailors management to patient and pathogen characteristics is an important goal for the field.

Keywords: Bacteremia; Diagnosis work-up; MRSA; MSSA; PSSA; Staphylococcus aureus; Treatment strategies.

Publication types

Review