title: Community-acquired Staphylococcus aureus bacteraemia in patients who do not abuse intravenous drugs.
abstract: Despite advances in antimicrobial therapy and intensive care support, Staphylococcus aureus continues to cause significant morbidity and mortality. We studied community-acquired S. aureus bacteraemia in a population where intravenous drug abuse is extremely uncommon, prospectively reviewing all such patients (n = 113) admitted to Groote Schuur Hospital from February 1986 to January 1991. Overall mortality was 35%. Factors associated with poor outcome were: confusion on presentation, failure to mount a febrile response, acute renal failure, adult respiratory distress syndrome, shock, endocarditis, disseminated intravascular coagulation and platelet count of < 100 x 10(9)/l. Only confusion, acute renal failure and shock were independently associated with death by stepwise regression analysis. Skin infections were the most commonly identified source of bacteraemia (22%), but in 58% of patients the source was not determined. Twenty-six percent of patients were diabetic. Almost all patients (90%) developed one or more complications. In those who survived, therapy was generally prolonged, with a median of 70 days and range of 7-393 days, depending on the associated complications. Community-acquired S. aureus bacteraemia is a serious condition associated with a high complication rate and mortality.
authors.affiliation: Department of Medicine, Groote Schuur Hospital, Observatory, South Africa. pwillcox@uctgshl.uct.ac.za
authors.forename: P A
authors.initials: PA
authors.lastname: Willcox
authors.forename: B L
authors.initials: BL
authors.lastname: Rayner
authors.forename: D A
authors.initials: DA
authors.lastname: Whitelaw
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D002648:Child; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D003221:Confusion / Q000150:complications; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications; D017192:Skin Diseases, Bacterial / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D013211:Staphylococcus aureus; D013997:Time Factors; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents