Staphylococcal bacteremia and endocarditis: state of the art.

The major clinical difficulties in bacteremic Staphylococcus aureus infections involve the following: (1) differentiation of infective endocarditis (IE) from non-IE staphylococcemias and (2) questions concerning optimum chemotherapy of deep-seated staphylococcemic infections. In this article, an algorithmic approach to the differentiation of S aureus IE from non-IE staphylococcemias will be developed, particularly in regard to specific clinical, echocardiographic, radioisotopic, and serological "markers" for recognizing patients as at "high risk" for underlying S aureus IE. Also, data will be presented relating to the controversies of monotherapy v combination chemotherapy in S aureus IE as well as in bacteremic S aureus infections caused by antibiotic-tolerant S aureus strains.