Does a patient with Staphylococcus aureus (S. aureus) bacteriuria require contact isolation?

From the Guidelines

No, a patient with Staphylococcus aureus (S. aureus) bacteriuria does not require contact isolation, as the risk of transmission to others is low, particularly in the absence of symptoms or other risk factors 1.

Key Considerations

• The patient's clinical scenario, overall condition, and local infection control policies should guide the decision on isolation precautions.
• Standard precautions, including proper hand hygiene before and after patient contact, should always be maintained regardless of isolation status.
• Contact isolation is generally reserved for patients with methicillin-resistant Staphylococcus aureus (MRSA) infections in wounds, respiratory secretions, or other sites where there is a significant risk of transmission.
• Staphylococcus aureus in urine alone often represents colonization rather than true infection and carries a low risk of transmission to others.

Clinical Context

In the context of real-life clinical medicine, the focus should be on preventing symptomatic infections, sepsis, or death, rather than solely on the presence of bacteriuria 1.

Evidence-Based Decision

The 2019 clinical practice guideline for the management of asymptomatic bacteriuria by the Infectious Diseases Society of America provides guidance on the management of patients with bacteriuria, emphasizing the importance of avoiding antimicrobials in hospitalized patients to prevent nosocomial infections with antimicrobial-resistant organisms 1.

Patient-Centered Approach

A patient-centered approach should prioritize the patient's quality of life, morbidity, and mortality, taking into account their individual risk factors and clinical scenario, rather than solely relying on the presence of S. aureus bacteriuria 1.

From the Research

Patient Isolation Requirements for Staphylococcus aureus Bacteriuria

• The need for contact isolation in patients with Staphylococcus aureus (S. aureus) bacteriuria is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, the studies suggest that S. aureus bacteriuria can be a sign of more invasive infections, such as S. aureus bacteremia, and may be associated with certain risk factors, including urinary catheterization, urological abnormalities, and comorbidities 2, 3, 4, 5.
• The management of S. aureus bacteriuria is still largely undetermined, and there is little guidance on investigation and treatment 2.
• Some studies suggest that repeat urine culture and investigation of higher-risk patients may be warranted, but routine taking of blood cultures or treatment of asymptomatic bacteriuria in well patients may not be necessary 2.
• The use of alternative treatment technologies, such as bacteriocins and phage therapy, is being explored to combat nosocomial MRSA infections, but more research is needed to determine their efficacy and safety 6.

Risk Factors for Symptomatic S. aureus-Related UTI

• Indwelling catheterization, renal stones, and hydronephrosis are significantly associated with S. aureus-related UTI 5.
• Hypoalbuminemia is also a risk factor for MRSA-related UTI 5.
• Paying attention to these risk factors may be an effective strategy for prevention of S. aureus-related UTI with persistent staphylococcal bacteriuria 5.

Clinical Relevance and Management of S. aureus Bacteriuria

• S. aureus bacteriuria can be secondary to bacteremia and systemic infection in some patients, but it may also predispose to bacteremia and invasive disease in others 4.
• The clinical relevance and management of S. aureus bacteriuria are still largely undetermined, and more research is needed to determine the best course of treatment 2, 4.