Complicating infectious foci in patients with Staphylococcus aureus or Streptococcus species bacteraemia.
until further notice
SourceEuropean Journal of Clinical Microbiology and Infectious Diseases, 26, 2, (2007), pp. 105-113
Article / Letter to editor
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Epidemiology, Biostatistics & HTA
European Journal of Clinical Microbiology and Infectious Diseases
SubjectEBP 2: Effective Hospital Care; IGMD 2: Molecular gastro-enterology and hepatology; IGMD 7: Iron metabolism; N4i 1: Pathogenesis and modulation of inflammation; N4i 2: Invasive mycoses and compromised host; NCEBP 14: Cardiovascular diseases; NCEBP 2: Evaluation of complex medical interventions; NCMLS 1: Immunity, infection and tissue repair; NCMLS 1: Infection and autoimmunity; ONCOL 3: Translational research; ONCOL 4: Quality of Care; ONCOL 5: Aetiology, screening and detection; UMCN 2.1: Heart, lung and circulation; UMCN 4.1: Microbial pathogenesis and host defense; UMCN 5.5: Nutrition and Health; EBP 2: Effective Hospital Care
Complicating infectious foci resulting from haematogenous or local spread of microorganisms are observed frequently in patients with Staphylococcus aureus bacteraemia (SAB) or Streptococcus species bacteraemia (SSB). The aim of this study was to compare the epidemiology of complicating infectious foci during SAB and SSB in a university hospital in The Netherlands. The charts of all adult patients diagnosed with SAB or SSB (except for Streptococcus pneumoniae bacteraemia) from July 2002 until December 2004 were reviewed retrospectively. Overall, 180 immunocompetent patients were identified, 127 with SAB and 53 with SSB. The percentage of patients with complicating infectious foci (39% of SAB patients, 25% of SSB patients) did not differ significantly between the groups. Endocarditis and cerebral involvement, however, were significantly more common in the SSB group. Of all complicating infectious foci, 32% lacked guiding signs or symptoms and 10% were detected only at autopsy. Factors associated with the development of complicating infectious foci were a delay in treatment for more than 48 h after the onset of symptoms, community acquisition, persistently positive blood cultures, congenital heart disease, and the presence of foreign bodies or prosthetic valves. Infection-related mortality was 18% in SAB patients and 11% in SSB patients and was significantly higher in patients with complicating infectious foci (29 vs. 9%). In conclusion, complicating infectious foci develop in approximately one-third of all patients with SAB and SSB. An active approach that entails searching for the complicating infectious foci is warranted in these patients, because only two-thirds of complicated infectious foci have guiding symptoms or signs, and infection-related mortality is significantly increased in patients with complicating infectious foci compared to patients without these infections.
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