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1994-08-27
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Document 0711
DOCN M9480711
TI The current spectrum of Staphylococcus aureus infection in a tertiary
care hospital.
DT 9410
AU Musher DM; Lamm N; Darouiche RO; Young EJ; Hamill RJ; Landon GC; Medical
Service, Veterans Affairs Medical Center, Houston, TX; 77030.
SO Medicine (Baltimore). 1994 Jul;73(4):186-208. Unique Identifier :
AIDSLINE MED/94316015
AB Staphylococcus aureus remains a prominent cause of community- and
hospital-acquired infection. This study reviewed 162 cases of S. aureus
infection occurring in 120 adults who were hospitalized at a Veterans
Affairs Medical Center and referred for consultation to the Infectious
Disease Service. There were 37 cases of skin and soft tissue infection,
5 pyomyositis, 34 osteomyelitis, 13 septic arthritis, 19 pneumonia, 3
empyema, 5 pyelonephritis, 37 vascular infection, 3 epidural abscess,
and 6 miscellaneous infections. Bacteremia was documented in 56 of 119
(47%) cases in which blood cultures were obtained, indicating the
serious nature of the infections in many cases. Staphylococcus aureus is
widely prevalent in healthy persons. Given its ubiquity and the capacity
to cause a broad array of infections, an effective host response must
play an important role in preventing infection. This host response is
immunologically nonspecific, in that it depends upon the effectiveness
of mechanical barriers to invasion and, once invasion takes place, the
interaction of PMN, complement, and antibody that is probably present in
serum of all immunologically competent adults rather than sensitization
of B or T lymphocytes by any identifiable antigens specific to S.
aureus. Analysis of the present cases calls attention to S. aureus as an
opportunistic pathogen, 1 that only infrequently causes serious
infection in otherwise healthy persons. Nearly every patient in this
series had 1 or more medical condition thought to predispose to
infection; 279 such conditions were identified, representing an average
of 2.3 per person. A break in the natural barrier to infection was also
present in the majority of cases, for example, trauma, wound, or
pre-existing decubitus ulcer in skin and soft tissue infections;
endotracheal tube in pneumonia; and a catheter bypassing urethra or skin
in urinary and vascular infections, respectively. The tendency for
patients to be infected with S. aureus repeatedly (mean number of
infections, 1.4 per patient) reflects the chronicity of many
predisposing factors and, perhaps, of colonization as well.
Staphylococcus aureus has a special predilection to cause infections
involving prosthetic devices, perhaps related to its affinity for
fibronectin, laminin, and other serum proteins that can mediate
attachment to foreign material; 46 of 162 (28%) infections were
associated with the presence of a foreign body. Such infections are
difficult to eradicate with antibiotic therapy alone, perhaps because of
a change in the metabolic state of adherent bacteria, and removal of the
foreign body is generally required for cure.(ABSTRACT TRUNCATED AT 400
WORDS)
DE Abscess/EPIDEMIOLOGY Adult Animal Cross Infection/*EPIDEMIOLOGY
Endocarditis/MICROBIOLOGY Female Hospitals, Animal Human HIV
Infections/COMPLICATIONS Joint Diseases/MICROBIOLOGY Male
Osteomyelitis/MICROBIOLOGY Pneumonia, Staphylococcal/EPIDEMIOLOGY
Pyelonephritis/MICROBIOLOGY Staphylococcal Infections/*EPIDEMIOLOGY
Staphylococcal Skin Infections/EPIDEMIOLOGY Support, U.S. Gov't,
Non-P.H.S. JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).