Staphylococcus aureus bacteremia in patients with hematologic disorders.
During the 20-year period, 1972-1991, 27 episodes of Staphylococcus aureus bacteremia, including 10 with methicillin-resistant strains (MRSA), were documented in 26 patients with hematologic disorders, mainly acute leukemia and malignant lymphoma, representing 6% of all 433 episodes of bacteremia in a hematology unit. MRSA replaced methicillin-sensitive strains (MSSA) in the last four years. The skin and upper respiratory tract were the two most common primary foci. Most episodes occurred during neutropenia. Pharyngeal colonization often preceded the development of bacteremia. Antibiotic therapy predisposed to MRSA acquisition during hospitalization, whereas MSSA was mostly detected in admission cultures. Among 22 patients with monomicrobial bacteremia, 19 (86%) survived longer than one week, including all four with MRSA bacteremia who received vancomycin. The survival rate did not differ materially between MRSA and MSSA bacteremias. Secondary foci, chiefly located in the lung, were found in 30% of all patients with S. aureus bacteremia. Prolonged antibiotic therapy, therefore, seems warranted in patients with evident metastatic lesions, although abbreviated therapy is proposed in neutropenic cancer patients.
Funada
H
H
Protected Environment Unit, Kanazawa University, Japan.
Yoneyama
H
H
Machi
T
T
Matsuda
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000382:microbiology*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014640:Vancomycin / Q000627:therapeutic use
D014640:Vancomycin