Staphylococcus aureus bacteremia and recurrent staphylococcal infection in patients with acquired immunodeficiency syndrome and AIDS-related complex1

Abstract

<h3>Purpose</h3> An increased incidence of <i>Staphylococcus aureus</i> bacteremia has recently been described in patients with the acquired immunodeficiency syndrome (AIDS). However, other risk factors for community-acquired <i>S. aureus</i> bacteremia (including intravenous drug abuse and lymphedema) were present in nearly all these AIDS-related cases of <i>S. aureus</i> infection. Our purpose was to review cases of <i>S. aureus</i> bacteremia that occurred in patients with AIDS or AIDS-related complex (ARC) who did not have a recent history of intravenous drug use, lymphatic obstruction, or neutropenia. <h3>Patients and methods</h3> Patients at San Francisco General Hospital between October 1984 and October 1987 with blood culture results positive for <i>S. aureus</i> were identified. A review of this group revealed 22 cases of <i>S. aureus</i> bacteremia that occurred in 18 patients with an underlying diagnosis of AIDS or ARC, none of whom had a recent history of intravenous drug use, lymphedema secondary to Kaposi's sarcoma, or neutropenia. <h3>Results</h3> An intravenous catheter was the single most important risk factor for <i>S. aureus</i> bacteremia and was identified as the source for bacteremia in 16 (73 percent) of the 22 episodes. Based on 1986 outpatient clinic records, we calculated an incidence of <i>S. aureus</i> bacteremia occurring in nonintravenous-drug-using male AIDS or ARC patients, 18 to 44 years old, that was 5.4 episodes/1,000 patients. Although the mean duration of appropriate antibiotic therapy was 18 days, late metastatic complications of <i>S. aureus</i> bacteremia occurred in six (35 percent) of 17 AIDS/ARC patients who survived initial antibiotic therapy. <h3>Conclusion</h3> Non-intravenous-drug-using AIDS and ARC patients (especially those with indwelling venous catheters) appear to be at high risk for <i>S. aureus</i> bacteremia, with a higher late metastatic complication rate than that reported for recent historical control subjects.