Finkelstein R, Sobel J D, Nagler A, Merzbach D
J Med. 1984;15(3):193-211.
Staphylococcus aureus bacteremia continues to be a frequent clinical problem even in communities where intravenous drug abuse is relatively rare. One-hundred-three evaluable cases of S. aureus bacteremia that occurred in a large tertiary care facility over a four year period (1979-1982) are reviewed. A comparison of nosocomial and community-acquired S. aureus bacteremia reveals several fundamental differences. Community-acquired S. aureus bacteremia frequently develops in the absence of a primary focus of infection and is more likely to result in endocarditis and secondary metastatic foci of clinical infection. In contrast, nosocomial S. aureus bacteremia tends to be diagnosed earlier, a primary site of portal entry is usually identified and endocarditis is less frequent as are secondary foci of infection. Irrespective of the epidemiological origin of S. aureus bacteremia, the mortality remains high particularly in nosocomial infection where the presence of severe underlying disease contributes to the high mortality. Methicillin resistant S. aureus adds a new dimension to the challenge of successful treatment of staphylococcal bacteremia.
即使在静脉药物滥用相对较少的社区，金黄色葡萄球菌菌血症仍然是一个常见的临床问题。本文回顾了在一家大型三级医疗中心四年期间（1979 - 1982年）发生的103例可评估的金黄色葡萄球菌菌血症病例。医院获得性与社区获得性金黄色葡萄球菌菌血症的比较揭示了几个基本差异。社区获得性金黄色葡萄球菌菌血症常在无原发性感染灶的情况下发生，更易导致心内膜炎和临床感染的继发性转移灶。相比之下，医院获得性金黄色葡萄球菌菌血症往往诊断较早，通常能确定主要的门户进入部位，心内膜炎较少见，感染的继发性病灶也较少。无论金黄色葡萄球菌菌血症的流行病学来源如何，死亡率仍然很高，尤其是在医院感染中，严重基础疾病的存在导致了高死亡率。耐甲氧西林金黄色葡萄球菌给成功治疗葡萄球菌菌血症的挑战增添了新的维度。
