Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
J Hosp Infect. 2011 Jun;78(2):102-7. doi: 10.1016/j.jhin.2011.03.010. Epub 2011 Apr 20.
Staphylococcus aureus bacteraemia (SAB) episodes identified in a prospective multicentre study during 1999-2002 (not including MRSA) were followed up by an infectious disease specialist. The aim of this study was to compare predisposing factors, disease progression and outcome of healthcare (HA)- and community (CA)-associated SAB. Of 430 SAB episodes, 232 (54%) were HA. The HA-SAB patients were significantly older and more chronically ill compared to CA-SAB. Deep infection foci prevalence within three days of onset of SAB for HA versus CA were deep-seated abscesses (26% vs 37%, P < 0.05), pneumonia [25% vs 31%, non-significant (NS)], osteomyelitis (24% vs 36%, P<0.01), permanent foreign body (24% vs 9%, P<0.001), endocarditis (11% vs 15%, NS), septic arthritis (9% vs 13%, NS) and no infection focus (3% vs 6%, NS). The case fatality rates for HA-SAB versus CA-SAB at 28 days were 14% vs 11% (NS). Independent risk factors according to multivariate analysis for a fatal outcome were age, chronic alcoholism, immunosuppressive treatment, ultimately or rapidly fatal underlying diseases, severe sepsis on the onset of SAB, S. aureus pneumonia and endocarditis. As a result of a prospective study design, meticulous infection foci search and infectious disease specialist follow-up of each SAB episode, the case fatality remained low and 97% of the HA-SAB episodes presented infection foci within three days of onset of bacteraemia.
在 1999-2002 年进行的一项前瞻性多中心研究中发现了金黄色葡萄球菌菌血症（SAB）病例（不包括耐甲氧西林金黄色葡萄球菌），由传染病专家进行随访。本研究旨在比较医疗保健（HA）和社区（CA）相关 SAB 的易患因素、疾病进展和结局。在 430 例 SAB 发作中，232 例（54%）为 HA。与 CA-SAB 相比，HA-SAB 患者年龄明显更大，且患有慢性病。HA 与 CA 在 SAB 发病后三天内深部感染灶的发生率分别为深部脓肿（26% vs 37%，P<0.05）、肺炎[25% vs 31%，无显著性差异（NS）]、骨髓炎（24% vs 36%，P<0.01）、永久性异物（24% vs 9%，P<0.001）、心内膜炎（11% vs 15%，NS）、化脓性关节炎（9% vs 13%，NS）和无感染灶（3% vs 6%，NS）。HA-SAB 与 CA-SAB 在 28 天的病死率分别为 14%和 11%（NS）。多因素分析显示，28 天病死率的独立危险因素为年龄、慢性酗酒、免疫抑制治疗、潜在疾病最终或迅速致命、SAB 发病时严重脓毒症、金黄色葡萄球菌肺炎和心内膜炎。由于前瞻性研究设计、对每个 SAB 发作进行细致的感染灶搜索以及传染病专家的随访，病死率仍然较低，97%的 HA-SAB 发作在菌血症发病后三天内出现感染灶。
