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[Devastating community-acquired Staphylococcus aureus bacteremia]
E J van der Wouden1, P H P Groeneveld
1Isala Klinieken, locatie Sophia, afd. Interne Geneeskunde, Postbus 10.400, 8000 GK Zwolle. ejvanderwouden@hetnet.nl
Abstract:
Three patients, two men aged 52 and 62 years and a woman aged 83 years, experienced non-specific flu-like symptoms for a few days but subsequently developed a complicated disease with multiple metastatic infections and endocarditis due to bacteraemia. Only the man aged 62 years had a port of entry, a finger wound. Two patients died. Community-acquired S. aureus bacteraemia is a much more serious disease than nosocomial bacteraemia. The community-acquired bacteraemia is characterised by the absence of a primary focus and non-specific flu-like symptoms in the beginning. This results in a long-duration bacteraemia with a high incidence of metastatic infections, endocarditis and a high mortality rate. A multidisciplinary treatment approach with a careful search for and treatment of endocarditic and metastatic infections in combination with long-duration, high-dose antibiotics is warranted.
Insights
Community-acquired Staphylococcus aureus bacteraemia presents with flu-like symptoms and can lead to severe metastatic infections and endocarditis, often with fatal outcomes. Early detection and aggressive multidisciplinary treatment are crucial for improving patient survival.
Area of Science:
- Infectious Diseases
- Bacteriology
- Clinical Medicine
Background:
- Staphylococcus aureus bacteraemia (SAB) is a significant cause of morbidity and mortality.
- Distinguishing community-acquired SAB from nosocomial SAB is critical for prognosis and management.
- Early symptoms of community-acquired SAB can be non-specific, mimicking influenza.
Observation:
- Three patients (52, 62-year-old males; 83-year-old female) presented with flu-like symptoms.
- These patients subsequently developed severe disease, including metastatic infections and endocarditis due to S. aureus bacteraemia.
- Only one patient had an identifiable port of entry (a finger wound); two patients died.
Findings:
- Community-acquired S. aureus bacteraemia is associated with a higher mortality rate compared to nosocomial bacteraemia.
- Absence of a primary focus and initial non-specific symptoms characterize community-acquired SAB.
- This leads to prolonged bacteraemia, frequent metastatic complications (including endocarditis), and increased fatality.
Implications:
- A high index of suspicion for community-acquired S. aureus bacteraemia is warranted in patients with severe, unexplained illness.
- Multidisciplinary treatment is essential, focusing on identifying and managing metastatic infections and endocarditis.
- Long-duration, high-dose antibiotic therapy is recommended for effective management and improved outcomes.