Pulmonary complications in patients with staphylococcal sepsis

Background: The aim of the present study was to determine the pulmonary fin dings in patients with sepsis caused by Staphylococcus aureus. Methods: The clinical and laboratory findings of 32 cases (82%) of pulmonar y involvement (secondary pneumonia) of 39 patients with sepsis caused by S. aureus were studied retrospectively. The criteria for the diagnosis of sep sis were clinical evidence of infection plus hyperthermia/hypothermia, tach ycardia, tachypnea and white blood cell abnormalities. Secondary pneumonia was diagnosed in patients who presented with staphylococcal disease at one or more non-pulmonary sites and who developed radiologic evidence of pulmon ary involvement during the course of illness. Results: Of the 32 patients, 23 were male and nine were female; the male to female ratio was 2.5/1. The ages of the patients ranged from 2 months to 1 4 years (7.87+/-4.71 years). Bronchopneumonic infiltration was bilateral in 18 patients and unilateral in 14 patients (20 patients (62.5%) had lobar c onsolidation). Pleurisy was noted in 12 (37.5%) patients; it was on the rig ht side in five patients, on the left in five patients and bilateral in two patients. In contrast, pneumatocele and pneumothorax were observed in seve n (21.9%) and four (12.5%) patients, respectively. Closed chest tubes were placed through a closed thoracotomy in five children who developed dyspnea, orthopnea with imminent respiratory failure and mediastinal shift. As well as the pulmonary involvement, arthritis was noted in 13 patients, osteomye litis in 11 patients, rash in six patients, pericarditis in five patients a nd renal failure in one patient. Staphylococcus aureus was isolated from bl ood culture in all except for seven cases. While S. aureus was isolated fro m blood culture in all of the 12 patients with pleurisy, it was isolated fr om pleural fluid in only two (16.6%) patients. Six of 32 patients died; the mortality rate was 18.75%. Conclusions: It was found that the rate of pulmonary involvement was as hig h as 82% in sepsis caused by S. aureus, and the pulmonary findings, includi ng bronchopneumonic infiltration and lobar consolidation, were frequently s een in S. aureus pneumonia, causing a mortality rate of 18.75%.