COMMUNITY-ACQUIRED STAPHYLOCOCCUS-AUREUS BACTEREMIA IN PATIENTS WHO DO NOT ABUSE INTRAVENOUS DRUGS

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.