Staphylococcus aureus Bacteremia/Endocarditis Management Note

Patient: [Patient full name]

Date/Time: [Note date and time]

MRN/DOB: [MRN] / [DOB]

One-Line Summary

[Single sentence: organism (MSSA/MRSA/pending), bacteremia status (persistent/cleared with last positive and first negative culture dates), presumed source (confirmed/suspected/unknown), endocarditis evaluation status (TTE/TEE result or pending), current antibiotic regimen]

Key Dates and Milestones

(Use exact dates/times. If unknown, write "Unknown—needs confirmation." If pending, write "Ordered—pending" with expected timeframe.)

• Index blood culture (first positive): [Date/time]
• Last positive culture: [Date/time]
• First negative culture: [Date/time]
• Effective anti-staphylococcal therapy started: [Date/time]
• Source control achieved: [Date/time and action(s) such as line removal, drainage, surgery]
• Echocardiography: TTE [ordered/performed/resulted: date], TEE [ordered/performed/resulted: date] (If not done, state rationale.)
• Planned End-of-Therapy (EOT) date: [Date] (State what event defines Day 0.)

Microbiology and Clearance

(List all blood cultures since index event. Use exact times. Mark pending cultures as pending.)

Date/Time Drawn	Site (peripheral vs line/lumen)	Result (organism; time to positivity or NGTD + incubation)	Susceptibilities (MSSA/MRSA; key agents)
[Date/time]	[Site]	[Result or Pending]	[Susceptibilities or Pending]

Clearance plan: [Follow-up culture cadence, criteria for "cleared," vascular access plan relative to clearance] (If already cleared, state date and criteria met.)

SAB Classification

(Classify as Uncomplicated, Complicated, or Indeterminate. Do not declare "Uncomplicated" unless each criterion below is explicitly supported with evidence.)

• Classification: [Uncomplicated / Complicated / Indeterminate—treat as complicated until proven otherwise]
• Endocarditis excluded: [Yes / No / Unknown] — [Modality, date, result]
• No retained prostheses/intravascular devices that cannot be removed: [Yes / No / Unknown] — [Supporting inventory]
• Follow-up cultures negative within expected window: [Yes / No / Unknown] — [Dates]
• Defervescence after effective therapy: [Yes / No / Unknown] — [Timing]
• No evidence of metastatic infection: [Yes / No / Unknown] — [Screen/imaging summary]
• Implications: [Duration pathway and work-up implications based on classification]

Endocarditis Evaluation

(Document risk features and diagnostic pathway. Use Present/Absent/Unknown. If a study is not indicated, provide rationale.)

Risk factors:

• Prosthetic valve or prior valve repair: [Present / Absent / Unknown]
• Prior infective endocarditis: [Present / Absent / Unknown]
• Known valve disease or new murmur: [Present / Absent / Unknown]
• Cardiac implantable electronic device (CIED): [Present / Absent / Unknown]
• Recent intravascular grafts or stents: [Present / Absent / Unknown]
• Hemodialysis dependence: [Present / Absent / Unknown]
• Injection drug use: [Present / Absent / Unknown]
• Persistent bacteremia or fever: [Present / Absent / Unknown]
• Embolic phenomena: [Present / Absent / Unknown]

TTE

• Status: [Ordered / Performed / Resulted / Not done—rationale]
• Date: [Date]
• Result summary: [Vegetations: Yes/No/Indeterminate; valve function; complications; image quality]

TEE

• Indication: [High-risk features / Non-diagnostic TTE / Prosthetic material / CIED / Unclear source / Other]
• Status: [Ordered / Performed / Resulted / Deferred—rationale and trigger for reconsidering]
• Date: [Date]
• Result summary: [Vegetations: Yes/No/Indeterminate; valve function; complications]

Duke Criteria Status

(Include when infective endocarditis is being actively considered.)

• Overall: [Definite / Possible / Rejected]
• Major criteria met: [Brief supporting facts]
• Minor criteria met: [Brief supporting facts]

Source Identification and Control

• Most likely source category: [Line-associated / Skin-soft tissue / Pneumonia / Osteoarticular / Urinary / Endovascular / Unknown]
• Supporting evidence: [Cultures, imaging, exam findings]
• Source control completed: [Action(s) with date and responsible service]
• Source control planned: [Action(s), responsible service, scheduled date]
• If source unknown: [Evaluation completed] and [Evaluation pending]

Device and Hardware Assessment

(Explicitly document presence or absence of high-stakes hardware. For each device present, document status, cultures, and plan.)

Intravascular Devices

• CVC/PICC/Tunneled catheter/Port: [Present / Absent] — [If present: removal status, date, tip culture, plan]
• Dialysis access: [Present / Absent] — [If present: type, status, plan]
• Recent vascular grafts or stents: [Present / Absent] — [If present: location, age, imaging, plan]

Cardiac Devices

• CIED: [Present / Absent] — [If present: type, implant date, pocket exam, imaging, EP/cardiology consult status]
• LVAD: [Present / Absent] — [If present: driveline/pocket assessment, imaging, consult status]
• Prosthetic valve: [Present / Absent] — [If present: type, position, age, imaging status]

Orthopedic and Other Hardware

• Prosthetic joints: [Present / Absent] — [If present: sites, symptoms, imaging/aspiration plan]
• Spine hardware: [Present / Absent] — [If present: symptoms, imaging plan]
• Other implants: [Present / Absent] — [If present: specify and evaluate]

Metastatic Infection Screen

(Use Present/Absent/Unable to assess. If unable to obtain history or exam, document limitation.)

Symptoms

• Back or neck pain (vertebral osteomyelitis/epidural abscess): [Present / Absent / Unable to assess]
• Joint pain or swelling (septic arthritis): [Present / Absent / Unable to assess]
• Focal neurologic deficits or severe headache (CNS involvement): [Present / Absent / Unable to assess]
• Chest pain or pleuritic symptoms (septic pulmonary emboli): [Present / Absent / Unable to assess]
• Abdominal or flank pain (splenic/renal infarct, psoas abscess): [Present / Absent / Unable to assess]
• Visual symptoms (endophthalmitis): [Present / Absent / Unable to assess]
• Persistent focal skin lesions: [Present / Absent / Unable to assess]

Exam Findings

• New murmur: [Present / Absent / Unable to assess]
• Peripheral stigmata of IE: [Present / Absent / Unable to assess]
• Focal spine or joint tenderness: [Present / Absent / Unable to assess]
• Focal neurologic findings: [Present / Absent / Unable to assess]

Imaging Performed/Planned

• [Modality, date]: Indication: [symptom/sign/risk]; Result: [summary or Pending]

Antimicrobial Therapy

• Current regimen: [Drug(s), dose, route, frequency, start date/time] (State if this is the effective therapy start date.)
• Dose adjustments: [Renal/hepatic adjustments and rationale]
• Allergy considerations: [Allergies and cross-reactivity considerations]
• Drug interactions: [Significant interactions and management]
• Targeted therapy rationale: [For MSSA: beta-lactam selection rationale; For MRSA: vancomycin vs daptomycin rationale] (Include once susceptibilities known.)
• Duration pathway: [Uncomplicated SAB / Complicated SAB / Definite IE / Possible IE / Other deep focus]; Day 0 defined as: [First negative culture / Source control date / Other]

Monitoring and Follow-Up

• Blood culture cadence: [Frequency until clearance and stop criteria]
• Laboratory monitoring: [Labs and frequency]
• Drug-specific monitoring: [Vancomycin: AUC or trough strategy; Daptomycin: CK frequency; Other agents]
• Clinical response: [Fever curve, hemodynamics, WBC trend]
• Failure/persistence triggers: [Criteria to escalate work-up and planned actions]
• Duration milestones: [Expected clearance date, echo completion target, source control target, weekly monitoring schedule, follow-up appointments, EOT date with required reassessment]
• If duration not final: [Interim minimum duration and contingencies that would extend therapy]

Disposition and OPAT

(Include when discharge planning is relevant.)

• OPAT candidacy: [Yes / No / Undetermined] — [Rationale]
• Line plan: [Type and timing relative to culture clearance]
• Home health/infusion: [Agency, delivery start, teaching status]
• Outpatient monitoring: [Responsible clinician, lab schedule, results review process]
• Oral step-down consideration: [Criteria met, endovascular infection excluded] (If not appropriate, state why.)

Communication and Accountability

• Consults involved: [Services]
• Key communications: [Primary team, patient/family discussions]
• Action items: [Task — Responsible party — Due date]