Many hemodialytic patients with S aureus bacteremia will die, and even among patients receiving antibiotics, the overall mortality rate of patients with S aureus bacteremia may be as high as 20%. S aureus bacteremia occurs among patients with end-stage renal disease (ESRD). The increasing prevalence of methicillin-resistant S aureus (MRSA) has prompted wider use of vancomycin to treat these patients, even though multiple studies suggest that beta lactams offer greater treatment efficacy in the management of methicillin-sensitive S aureus (MSSA).

Vancomycin was associated with the best outcomes among patients with MRSA. Clinicians may not prescribe cefazolin for these patients because they do not realize that it may be more effective than vancomycin. There are currently no renal practice guidelines for the treatment of bloodstream infection in hemodialysis which would likely decrease such clinical variability in infection care.