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International Journal of Microbiology
Volume 2010, Article ID 654858, 7 pages
http://dx.doi.org/10.1155/2010/654858
Research Article

Clinical and Microbiological Determinants of Outcome in Staphylococcus aureus Bacteraemia

1Medical Research Building, Brighton and Sussex Medical School, University of Sussex, Falmer BN1 9PS, UK
2Department of Microbiology and Infection, Brighton and Sussex Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK
3Faculty of Medicine, St Mary's Campus, Imperial College, London W2 1PG, UK
4St Georges Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK

Received 5 November 2009; Accepted 8 February 2010

Academic Editor: Michael M. Tunney

Copyright © 2010 James Price et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Staphylococcus aureus bacteraemia (SAB) is commonly complicated by metastatic infection or relapse after treatment. Objectives. The study aim was to determine the role of bacterial, host, and management factors in development of complicated SAB. Methods. A prospectively-conducted observational study gathered data on predisposition, management and outcome of 100 consecutive SAB cases. Antibiotic susceptibilities and genetic lineage of bacterial isolates were determined. Further clinical and microbiological data were gathered on two retrospective series from 1999–2000 ( ) and 2004 ( ). Results. In the prospective cases, 27% met our definition of complicated disease. Expressed as RR and 95% CI, complicated disease was associated with diabetes (1.58, 1.00–2.48), injecting-drug use (5.48, 0.88–33.49), community-onset of symptoms (1.4, 1.02–1.92), and symptom duration hours prior to starting effective antibiotic therapy (2.10, 1.22–3.61). Uncomplicated disease was associated with the presence of a central line (0.69, 0.55–0.88) and prompt removal of a primary focus (0.71, 0.57–0.90). Neither methicillin resistance nor genetic lineage was associated with complicated disease, but methicillin resistance was associated with higher mortality. Conclusions. This study demonstrates that clinical rather than microbial factors are the major determinants of SAB outcome and underscores the importance of early treatment.