A Closer Look at IDSA/ESCMID 2026 Consensus Statements 6 and 7 on Staphylococcus aureus Bacteremia
IDSA and ESCMID released 7 consensus statements to assist in managing individuals with Staphylococcus aureus Bacteremia (SAB). This review will focus on the adult patient population and additional information on pediatric population statements can be assessed in the guideline.
On September 9, the Infectious Disease Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Disease (ESCMID) released Part 1 of the latest Consensus Statements on Staph aureus Bacteremia (SAB), including risk stratification, diagnostic evaluation and management of adults and children.1 SAB is the leading cause of death from blood stream infection and causes substantial morbidity due to frequent deep-seated and metastatic foci of infection.1 Consensus Statements 6 and 7 addressed the following questions:
Consensus Statement 6
“Should patients stratified as low-risk SAB and classified as without deep-seated or metastatic foci of infection after diagnostic evaluation receive antibiotic therapy for 14 days, less than 14 days, or more than 14 days?”
Consensus Statement 7
“Should patients stratified as increased-risk SAB but classified as without deep-seated or metastatic foci of infection after diagnostic evaluation receive antibiotic treatment of 14 days of longer?”
Why is This Important?
The ideal duration of therapy for individuals with SAB is unknown.2 Healthcare providers often utilize long durations of antibiotic therapy to avoid undertreatment.2 The optimal duration of therapy should balance effective treatment with risk of drug toxicity and prolonged therapy.2Consensus Statement 1 addresses risk stratification for deep-seated or metastatic foci of infection.1 Consensus Statement 6 addresses the optimal duration of therapy for individuals categorized as low-risk SAB and without evidence of deep-seated or metastatic foci of infection, while Consensus Statement 7 addresses those stratified as increased-risk SAB but without deep-seated or metastatic foci of infection.2,3
Consensus Statement 6 and 7 Summary
The Consensus Statements suggest an antibiotic treatment of 14 days in adults categorized as low-risk AND increased-risk SAB without deep-seated or metastatic foci of infections after diagnostic evaluation.2,3 These statements also consider appropriate management of follow-up blood cultures and blood culture clearance as outlined in Consensus Statement 2.1,2,3 The day of blood culture clearance should be utilized as the start date of treatment.2 The date of focus removal can be considered as the start date of therapy if this occurs after blood culture clearance.2,3
Per Consensus Statement 6, the literature does not suggest s benefit treating patients with low-risk SAB and without deep-seated or metastatic foci of infections for any longer than 14 days.2 Prolonged treatment can put the patient at risk for adverse outcomes, including adverse drug reactions and complications associated with prolonged hospitalization, including venous thromboembolism and additional infections.2 The Statement also suggests global feasibility of administering 14 days of therapy in most clinical settings.2 Treatment less than 14 days should only be guided by an Infectious Disease specialist after careful risk assessment.2 Additionally, treatment duration beyond 14 days can be reconsidered depending on the clinical course of the individual patient, such as situations where deep-seated infections are found.2 The Statement also suggests all previous consensus statements are followed to guide duration of treatment, including appropriate follow-up blood cultures and use of TTE and TEE.2 All patients should also be educated on signs and symptoms warranting medical re-evaluation. 2
Extended durations of antibiotics also provide the same risks in patients with increased-risk SAB, however Consensus Statement 7 also suggests a 14 days course of treatment balances the risks versus benefits.3 The statement reinforces an improvement in signs and symptoms of infection and ongoing clinical assessment should not indicate a deep-seated or metastatic focus is present.3 Patients categorized as increased-risk SAB based on positive blood cultures obtained ≥ 48 hours after the first positive blood culture should have additional evaluation for deep-seated or metastatic focus of infection.3
Consensus Statement 7 also recognizes certain clinical situations where device related or endovascular infection may be difficult to exclude, including retained intracardiac devices and recently placed endovascular grafts.3 In these clinical situations, the statement suggests considering additional source control and/or > 14 days of antibiotic therapy targeting the suspected focus.3 Additionally, the statement suggests those with prolonged bacteremia ≥ 48 hours after the first positive blood culture should have course of therapy guided by clinical course, tailored diagnostic evaluation, and likely focus of infection.3 If any focus of infection is identified that merits antibiotic treatment beyond 14 days, then this focus should dictate the final duration of therapy.3
Barriers To Implementation
The statement recognizes the potential differences in the discharge protocol of facilities, including limited access to outpatient antibiotic infusions and transition to appropriate oral or long acting therapies.2 Limited access to follow-up upon discharge may also pose a barrier to assess for infection resolution and new signs and symptoms that may suggest a relapse or new site of infection.2 Also, the availability of certain diagnostic tools to evaluate for deep-seated infections may vary between different healthcare organizations.3 Limited evidence addressing certain patient populations may lead to under or over treatment.3 Also, lack of infectious disease services may limit risk-based clinical assessments to determine the optimal treatment duration in certain individuals.3
It is important to note than the manuscript utilized a consensus-based methodology when developing. The consensus statement also recognizes tailoring these approaches to individual clinical patient scenarios is necessary and the guidelines cannot always account for individual variation among patients.2,3
References
1.IDSA/ESCMID 2026 Consensus Statements on Staphylococcus aureus Bacteremia: Risk Stratification, Diagnostic Evaluation, and Management of Adults and Children. Updated September 9, 2026. Accessed October 27, 2026. https://www.idsociety.org/practice-guideline/staphylococcus-aureus-bacteremia/
2.Strnad L, Shopsin B, Holubar M, et al. 2026 Consensus Statement 6 by the IDSA and ESCMID on the Duration of Antibiotic Therapy in Low-Risk Patients with SAB without Evidence of Deep-Seated or Metastatic Foci of Infection. Updated September 9, 2026. Accessed October 27, 2026. https://www.idsociety.org/globalassets/idsa/practice-guidelines/sab/consensus-statement-2.-follow-up-blood-cultures-manuscript.pdf#page=1
3.Holubar M, Shopsin B, Cunnington AJ, et al. 2026 Consensus Statement 7 by the IDSA and ESCMID on the Duration of Antibiotic Therapy in Patients with Increased-Risk SAB without Evidence of Deep-Seated or Metastatic Foci of Infection
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