Therapy of staphylococcal septicaemia in compromised hosts

Despite advances in antibiotic therapy, infection remains one of the major causes of death in compromised patients, and the severity of the underlying disease often determines the outcome of the infectious disease. During a 5-year period (July 1, 1974--June 30, 1979), septicaemia was diagnosed in 604 patients admitted to Haukeland Hospital, and 175 (29%) of these patients died. 640 septic episodes occurred in the 604 patients, and 684 bacterial strains were isolated from the blood. Staphylococcus aureus and Staphylococcus epidermidis accounted for 96 (14%) and 45 (6.6%) of the causative strains, respectively. 85 patients had septicaemia caused by S. aureus and 40 by S. epidermidis. 19 (22.4%) patients with S. aureus septicaemia and 9 (22.5%) with S. epidermidis septicaemia died. 12 of 21 (57%) patients with S. aureus or S. epidermidis septicaemia and underlying malignant disease died and only 16 of 104 (15%) patients with staphylococcal septicaemia and non-malignant disease. More than 96% of the S. aureus strains were susceptible to isoxazolylpenicillins, cephalothin, lincomycin or gentamicin, but only 18% to benzylpenicillin. The S. epidermidis strains were less susceptible to lincomycin and gentamicin. Single antibiotic treatment (a penicillin, cephalosporin or vancomycin) seemed as effective in staphylococcal septicaemia as combined penicillin/aminoglycoside therapy or other combinations. In compromised patients staphylococcal septicaemia is often fulminant, and antimicrobial therapy must be started as soon as specimens for microbiological cultures are obtained. So far, there is no clinical proof that antibiotic combination therapy is superior to single drug treatment. However, if penicillins can not be used or the response to single drug therapy is poor, combination therapy should be considered.