title: Predisposing factors, disease progression and outcome in 430 prospectively followed patients of healthcare- and community-associated Staphylococcus aureus bacteraemia.
abstract: Staphylococcus aureus bacteraemia (SAB) episodes identified in a prospective multicentre study during 1999-2002 (not including MRSA) were followed up by an infectious disease specialist. The aim of this study was to compare predisposing factors, disease progression and outcome of healthcare (HA)- and community (CA)-associated SAB. Of 430 SAB episodes, 232 (54%) were HA. The HA-SAB patients were significantly older and more chronically ill compared to CA-SAB. Deep infection foci prevalence within three days of onset of SAB for HA versus CA were deep-seated abscesses (26% vs 37%, P < 0.05), pneumonia [25% vs 31%, non-significant (NS)], osteomyelitis (24% vs 36%, P<0.01), permanent foreign body (24% vs 9%, P<0.001), endocarditis (11% vs 15%, NS), septic arthritis (9% vs 13%, NS) and no infection focus (3% vs 6%, NS). The case fatality rates for HA-SAB versus CA-SAB at 28 days were 14% vs 11% (NS). Independent risk factors according to multivariate analysis for a fatal outcome were age, chronic alcoholism, immunosuppressive treatment, ultimately or rapidly fatal underlying diseases, severe sepsis on the onset of SAB, S. aureus pneumonia and endocarditis. As a result of a prospective study design, meticulous infection foci search and infectious disease specialist follow-up of each SAB episode, the case fatality remained low and 97% of the HA-SAB episodes presented infection foci within three days of onset of bacteraemia.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. erik.forsblom@helsinki.fi
authors.forename: E
authors.initials: E
authors.lastname: Forsblom
authors.forename: E
authors.initials: E
authors.lastname: Ruotsalainen
authors.forename: T
authors.initials: T
authors.lastname: Mölkänen
authors.forename: J
authors.initials: J
authors.lastname: Ollgren
authors.forename: O
authors.initials: O
authors.lastname: Lyytikäinen
authors.forename: A
authors.initials: A
authors.lastname: Järvinen
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D015984:Causality; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents