Staphylococcus aureus in the Urine: What to Do Next?

Advances in environmental sanitation, immunizations, antimicrobial therapy, and medical research have greatly reduced the impact of infectious diseases (IDs) on our communities. Nonetheless, infections and the cost of treating them remain a burden to the health care system.

In primary care practice, we may spend more time making referrals for suspected ID than actually treating infected patients. Here, as a brush up, is the third in our series of 10 practical ID pearls.

3. Should oral antibiotics be initiated for a patient when Staphylococcus aureus (MRSA or MSSA) is isolated in the urine?

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Answer: The presence of Staphylococcus aureus in the urine should prompt a search for another site of infection.

Urine is not typically the primary source of staphylococcal infection, unless the patient has an indwelling Foley catheter or recently underwent a genitourinary procedure. Assessment should focus on potential sources of the staphylococcal infection, such as endocarditis, osteomyelitis, or skin abscesses. Staphylococcal infection is a particular risk for immunocompromised patients and for newborns; the elderly; drug abusers; and patients with diabetes, cancer, or pulmonary or vascular disease.

Reference

Muder, RR, Brennen, C, Rihs J, et al. Isolation of Staphyloccocus aureus from the urinary tract: association of isolation with symptomatic urinary tract infection and subsequent staphylococcal bacteremia. Clin Infect Dis. 2006;42:46-50. Accessed on August 16, 2013 and available, here.  (Full text)

Practical ID Pearl #1

Pracitcal ID Pearl #2