The Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) just released a new 2026 consensus statement regarding Staphylococcus aureus bacteremia (SAB), Staphylococcus aureus Bacteremia: Risk Stratification, Diagnostic Evaluation, and Management of Adults and Children. The new IDSA/ESCMID guidance is for healthcare professionals who have adult and/or pediatric patients with SAB. The consensus statements are mirrored into two groups for adult and pediatric patients. The guidance focuses on risk stratification, follow-up blood cultures, transthoracic echocardiography, and more.

Below, we’re featuring the twenty consensus statements featured in the guidance. For a complete look at each statement along with accompanying remarks and rationale, view the full-text version of the 2026 IDSA/ESCMID guidance on SAB.

Consensus Statements from IDSA/ESCMID 2026 Guidance on SAB

Risk Stratification in Adults

  • The panel suggests stratification based on risk factors associated with deep-seated or metastatic foci of infection or relapse of infection and ongoing clinical assessment to guide the diagnostic evaluation, and treatment plan.
  • Because individual risk factors lack sufficient negative predictive value to exclude deep-seated or metastatic foci of infection, the panel suggests a risk stratification approach using:
    • Key risk factors consistently associated with deep-seated or metastatic foci of infection or relapse of infection: community-onset SAB; positive blood culture obtained ≥48 hours after the first positive blood culture; and presence of an intracardiac device AND:
    • Other important risk factors: predisposing heart valve conditions, injection drug use, endovascular graft, SAB in prior 90 days, signs or symptoms of a deep-seated or metastatic focus of infection, embolic events, more than one non-contiguous focus of infection, and unknown focus.

Risk Stratification in Pediatric Patients

  • The panel suggests that all children with SAB are evaluated for a deep-seated focus of infection.
  • Data are insufficient to define a subgroup of children with SAB who are at low risk of deep-seated or metastatic foci of infection or relapsed bacteremia.

Follow-Up Blood Cultures in Adults

  • In adult patients with SAB, the panel suggests at least 2 sets of FUBC be obtained at 48 hours after sampling of the first positive blood culture and then repeated as either 1 or 2 sets every 24 to 48 hours until negative to document blood culture clearance.

Follow-Up Blood Cultures in Pediatric Patients

  • In pediatric patients with SAB, the panel suggests FUBC be obtained at 48 hours after sampling of the first positive blood culture and then repeated every 24 to 48 hours until negative to document blood culture clearance.

Transthoracic Echocardiography in Adults

  • The panel suggests routinely performing TTE in all adults with SAB, since the panel could not identify criteria to clearly define a population at very low risk of infective endocarditis.

Transthoracic Echocardiography in Pediatric Patients

  • TTE should be routinely performed in children with SAB who have structural heart disease, prolonged bacteremia, or signs and symptoms suggestive of endocarditis, but may be omitted in the absence of such factors and with low suspicion for endocarditis.

Transesophageal Echocardiography in Adults

  • The panel suggests performing TEE in adults with SAB who have a negative TTE, even if the TTE is of good quality if any of the following endocarditis increased-risk features are present:
    • Intracardiac device (e.g., prosthetic heart valve, permanent pacemaker, automatic implantable cardioverter-defibrillator, left ventricular assist device); Predisposing heart valve conditions including prior endocarditis; Positive follow-up blood cultures≥ 48 hours after the first positive blood culture; Embolic events; More than one non-contiguous focus of infection.
  • The panel suggests consideration of TEE in adults with SAB with community-onset or injection drug use as an endocarditis increased-risk feature. The decision to perform TEE should be guided by TTE quality and interpretability, presence of other endocarditis increased-risk features, clinical response, and anticipated impact on management.
  • The panel suggests that TEE may be unnecessary in adults with SAB who have a negative good quality TTE and are without any endocarditis increased-risk features as outlined in below Remarks and Consensus Statement 1.

Transesophageal Echocardiography in Pediatric Patients

  • The panel suggests not performing TEE in most pediatric patients with SAB and good quality TTE images. TEE has limited additional diagnostic utility over TTE for exclusion of endocarditis in most young children.
  • TEE should be considered in pediatric patients when TTE is negative or indeterminate AND there is high clinical suspicion of endocarditis.

Whole Body Imaging in Adults

  • In adult patients with SAB at increased risk for deep-seated or metastatic foci of infection and with an unknown focus after appropriate initial evaluation, the panel suggests performing either:
    • Whole-body imaging (WBI) (e.g., [18F]FDG-PET/CT) OR: Combinations of imaging modalities (e.g., thoracic/ abdominal CT, duplex venous ultrasound, etc.) that evaluate the most likely sites of infectious foci.

Whole Body Imaging in Pediatric Patients 

  • In pediatric patients with SAB without a focus after appropriate initial evaluation, whole-body imaging (e.g., [18F]FDG-PET/CT or other modality or combination of modalities) should be considered in carefully selected situations (e.g., ongoing SAB and no identifiable focus despite targeted evaluation).

Duration of Therapy in Low-Risk SAB without Deep-Seated or Metastatic Foci of Infection in Adults

  • In adult patients stratified as low-risk SAB and classified as without deep-seated or metastatic foci of infection after diagnostic evaluation, the panel suggests an antibiotic treatment duration of 14 days rather than longer or shorter courses.

Duration of Therapy in Low-Risk SAB without Deep-Seated or Metastatic Foci of Infection in Pediatric Patients

  • Data are insufficient to define a population of pediatric patients with SAB who have a low risk of deep-seated or metastatic foci of infection or relapse of infection.
  • In otherwise healthy pediatric patients with SAB and no evidence of deep-seated or metastatic foci of infection after appropriate evaluation, the panel suggests an antibiotic duration of 14 days.

Duration of Therapy in Increased-Risk SAB without Deep-Seated or Metastatic Foci of Infection in Adults

  • In adult patients stratified as increased-risk SAB but classified as without deep-seated or metastatic foci of infection after diagnostic evaluation, the panel suggests antibiotic treatment for 14 days.

Duration of Therapy in Increased-Risk SAB without Deep-Seated or Metastatic Foci of Infection in Pediatric Patients

  • In pediatric patients with SAB without deep-seated or metastatic foci of infection after diagnostic evaluation, the panel suggests antibiotic treatment for 14 days.

Check out our other infectious diseases-related content and be sure to sign up for alerts to stay informed on the latest published guidelines and articles.