Pa. Willcox et al., COMMUNITY-ACQUIRED STAPHYLOCOCCUS-AUREUS BACTEREMIA IN PATIENTS WHO DO NOT ABUSE INTRAVENOUS DRUGS, QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS, 91(1), 1998, pp. 41-47
Despite advances in antimicrobial therapy and intensive care support,
Staphylococcus aureus continues to cause significant morbidity and mor
tality. We studied community-acquired S. aureus bacteraemia in a popul
ation where intravenous drug abuse is extremely uncommon, prospectivel
y reviewing all such patients (n=113) admitted to Groote Schuur Hospit
al from February 1986 to January 1991. Overall mortality was 35%. Fact
ors associated with poor outcome were: confusion on presentation, fail
ure to mount a febrile response, acute renal failure, adult respirator
y distress syndrome, shock, endocarditis, disseminated intravascular c
oagulation and platelet count of <100x10(9)/l. Only confusion, acute r
enal failure and shock were independently associated with death by ste
pwise regression analysis. Skin infections were the most commonly iden
tified source of bacteraemia (22%), but in 58% of patients the source
was not determined. Twenty-six percent of patients were diabetic. Almo
st all patients (90%) developed one or more complications. In those wh
o survived, therapy was generally prolonged, with a median of 70 days
and range of 7-393 days, depending on the associated complications, Co
mmunity-acquired S. aureus bacteraemia is a serious condition associat
ed with a high complication rate and mortality.