Days Of Positive Blood Culture Research Articles

Effect of rapid cefpodoxime disk screening for early detection of third-generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae bacteremia

BackgroundSeveral methods have been reported for detecting resistance genes or phenotypic testing on the day of positive blood culture in Escherichia coli or Klebsiella pneumoniae bacteremia. However, some facilities have not introduced these methods because of costs or other reasons. Toyota Kosei Hospital introduced cefpodoxime (CPDX) rapid screening on May 7, 2018, to enable early detection of third-generation cephalosporin resistance. In this study, we aimed to evaluate the effects of intervention with an Antimicrobial Stewardship Team using CPDX rapid screening.MethodsCefotaxime (CTX)-resistant E. coli or K. pneumoniae bacteremia cases were selected retrospectively and divided into two groups: the pre-CPDX screening (June 1, 2015, to May 6, 2018) and CPDX screening groups (July 7, 2018, to August 31, 2021). The primary outcome was the proportion of cases in which modifications were made to the administration of susceptible antimicrobial agents within 24 h of blood culture-positive reports.ResultsOverall, 63 patients in the pre-CPDX screening group and 84 patients in the CPDX screening group were eligible for analysis. The proportion of patients who modified to susceptible antimicrobial agents within 24 h of blood culture-positive reports was significantly increased in the CPDX screening group compared to that in the pre-CPDX screening group (6.3% vs. 22.6%, p = 0.010).ConclusionThe results demonstrated that in CTX-resistant E. coli or K. pneumoniae bacteremia, CPDX rapid screening increased the proportion of early initiation of appropriate antimicrobial agents.

Impact of EUCAST rapid antimicrobial susceptibility testing (RAST) on management of Gram-negative bloodstream infection

ObjectivesDuring bloodstream infections, reducing the time to antimicrobial susceptibility testing is crucial to initiation of early appropriate antibiotic therapy. For Gram-negative infections, a phenotypic approach remains necessary. Rapid antimicrobial testing (RAST) is a recently developed phenotypic EUCAST method. The goal of this study was to evaluate the accuracy and clinical impact of RAST. Patients and methodsFrom September 2020 to August 2021, Gram-negative episodes with positive blood culture detected in the morning were included in the RAST group. Categorical agreement of RAST with conventional antimicrobial testing on strains was determined. To assess antibiotic management and patient outcomes, the RAST group was compared with a control group (CG) with positive blood culture detected in the afternoon for which overnight antimicrobial testing was performed. ResultsThe RAST group included 61 episodes from 61 patients, while the CG group included 49 episodes from 48 patients. While RAST performed on 41 E. coli, 11 K. pneumoniae and 9 P. aeruginosa strains highlighted 99.3 % of categorical agreement, 7.4 % of unreadable zones and 9.4 % of technical uncertainty area at 4 h incubation were also reported.For the RAST group, effective antibiotic therapy was prescribed in 100 % of patients on the day of positive blood culture (day 1) vs 88 % in CG (p = 0,007). As for beta-lactams on day 1, RAST led to 9 escalations and 6 de-escalations. Mortality and length of hospital stay did not significantly differ between the two groups. ConclusionRAST improves management of antibiotic therapy in patients with Gram-negative sepsis.

A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections?

IntroductionHealthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes.MethodsITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality.ResultsFour hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77–6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27–6.44) and Charlson index (aOR 1.11; 95% CI 1.01–1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40–0.93) were less likely to present clinical cure.ConclusionThe rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00537-0.

252. Increased incidence rates of positive blood cultures shortly after chemotherapy treatment initiation among individuals treated for solid malignant tumours

BackgroundCancer treatments suppress immune function and are associated with increased risk of infections, but the overall burden of serious infectious diseases in treated patients has not been clearly elucidated.MethodsAll patients treated for solid malignant tumours with curative intent radiotherapy (RT) and/or standard first line chemotherapy (C) at the Department of Oncology at Rigshospitalet between 01/1/2010 to 31/12/2016 were included. Patients were followed from treatment initiation to new cancer treatment, end of follow up or death whichever came first. We calculated incidence rates (IR) of positive blood culture (PBC) per 1000 person years follow up using Kaplan-Meier methods, and examined the proportion who died within 30 days of PBC.Results13,275 individuals were included, 4,372 (33%), 6,349 (48%), and 2,554 (19%) treated with RT, C, or concomitant RT&C, respectively, contributing 21,493 person years follow-up. 6,930 (52%) were female, the median (IQR) age was 63 (53, 70), and the most common cancer diagnoses were breast (n = 2,593 [19%]), colorectal (n=1,422 [11%]), and stomach (n=1,246 [9%]).Overall, 564 individuals (4%) experienced 746 unique episodes of PBC, 188, 408, and 150 events in 143, 311 and 110 individuals treated with RT, C, and RT&C, of which 49 (26%), 104 (25%), 38 (25%) died within 30 days of PBC, respectively. IR of PBC significantly varied by treatment: 13.0 (95% confidence interval 11.1, 15.4), 43.9 (39.3, 49.0) and 32.0 (26.5, 38.5) per 1000 person-years follow up in the RT, C and RT&C groups, respectively (IR ratio = 3.36 (2.75, 4.10) and 2.45 (1.91, 3.14) for C and RT&C compared to RT, respectively) and time since treatment (figure). Escherichia coli (n=185, 25%), Staphylococcus aureus (n=102, 14%), Klebsiella pneumoniae (n=76, 10%), Enterococcus faecium (n=48, 6%), and Enterococcus faecalis (n= 37, 5%) were the top 5 microorganisms identified and did not vary by treatment category, p = 0.11, there were 31 (4%) cases of Candida.Incidence rate of positive blood culture (PBC) by time since treatment initiation (0–3 months, 0–6 months and >6 months) and the proportion who died within 30 days of PBC by treatment type among individuals treated for solid malignant tumours with radiotherapy [RT], chemotherapy [C] and concomitant RT&C at Department of Oncology at Rigshospitalet, University of Copenhagen between 01/1//2010 to 31/12/2016. ConclusionPBCs are seen more often within 3 – 6 months after C than after RT alone. PBCs are not common, but when they occur, mortality is high. More precise risk factors for PBC and prophylactic means and empiric treatments in selected high-risk patients should be investigated.Disclosures All Authors: No reported disclosures

Infectious Diseases Consultation Is Associated With Decreased Mortality in Enterococcal Bloodstream Infections.

Background Enterococcus species frequently cause health care–associated bacteremia, with high attributable mortality. The benefit of consultation with infectious disease (ID) specialists has been previously illustrated with Staphylococcus aureus bacteremia. Whether ID consultation (IDC) improves mortality in enterococcal bacteremia is unknown.MethodsThis is a retrospective cohort single-center study from January 1, 2015, to June 30, 2016, that included all patients >18 years of age admitted with a first episode of Enterococcus bacteremia. Patients were excluded if death or transfer to palliative care occurred within 2 days of positive blood culture.ResultsTwo hundred five patients were included in the study, of whom 64% received IDC. Participants who received IDC were more likely to undergo repeat cultures to ensure clearance (99% vs 74%; P < .001), echocardiography (79% vs 45%; P < .001), surgical intervention (20% vs 7%; P = 0.01), and have appropriate antibiotic duration (90% vs 46%; P < .001). Thirty-day mortality was significantly higher in the no-IDC group (27 % vs 12 %; P < .007). In multivariate analysis, 30-day in-hospital mortality was associated with both E. faecium bacteremia (adjusted odds ratio [aOR], 2.39; 95% confidence interval [CI], 1.09–5.23) and IDC (aOR, 0.35; 95% CI, 0.16–0.76).ConclusionsPatients who received IDC for Enterococcus bacteremia had significantly lower 30-day mortality. Further prospective studies are necessary to determine if these outcomes can be validated in other institutions for patients who receive IDC with Enterococcus bacteremia.

Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes.

Persistent Staphylococcus aureus bacteremia (SAB) is defined based on varying duration in literature. The primary objective was to determine the risk of poor outcomes in relation to bacteremia duration. Multicenter, prospective, observational study of adult hospitalized patients with SAB. Medical records were reviewed for pertinent data. Patients were grouped by bacteremia duration: short (1-2 days), intermediate (3-6 days), and prolonged (≥7 days) and compared for risk factors and outcomes. Of 884 patients, 63% had short, 28% intermediate, and 9% prolonged bacteremia. Overall mean age was 57 years, and 70% were male. The prolonged group had the highest proportion of methicillin-resistant SAB (P < .0001). Choice of antibiotic therapy did not significantly affect bacteremia duration; however, time to source-control procedure was delayed in the prolonged and intermediate groups compared with the short group (3.5 vs 3 vs 1 day, P < .0001). Metastatic complications, length of stay, and 30-day mortality were progressively worse as bacteremia duration increased (P < .0001). Every continued day of bacteremia was associated with a relative risk of death of 1.16 (95% confidence interval, 1.10-1.22; P < .0001), with a significant increase in risk starting at 3 days as determined by receiver operating characteristic analysis. Optimal management of SAB should target bacterial clearance as soon as possible to minimize incremental risk of mortality with each day of positive blood culture. Delay in source control but not type of antistaphylococcal therapy was significantly associated with prolonged bacteremia and worse outcomes.

Duration and Persistence of Staphylococcus Aureus Bacteremia: A Prospective Cohort Study

Background: The purpose of the study was to describe and compare duration of Staphylococcus aureus bacteremia (SAB) according to methicillin resistance and primary foci of infection. We also aimed to redefine persistent SAB considering those results. Methods: We analyzed non-duplicated episodes of SAB in adult patients from three prospective SAB cohorts encompassing 14 hospitals in Korea. The duration of SAB was defined as the number of days from the administration of a susceptible antibiotic after the onset of SAB to the last day of positive blood culture for S. aureus. SAB durations were described and compared based on methicillin resistance and the primary foci of infection. The Cox proportional hazards regression was performed to explore independent risk factors for prolonged bacteremia. Cases in the top quartile for the duration of bacteremia were designated as newly-defined persistent SAB. Findings: A total of 2050 cases were analyzed. The duration of SAB was longer in methicillin-resistant SAB (MRSAB) than in methicillin-susceptible SAB (MSSAB) (median [IQR], 1 [1-3] in MSSAB vs. 1 [0-7] in MRSAB, p < 0.001). While the duration of bacteremia was shortest in the skin and soft tissue infections, they were longer in endocarditis, bone and joint, and endovascular infections, and were independently associated with those foci of infection. Newly-defined persistent SAB showed independent association with in-hospital mortality (aOR, 1.99; 95% CI, 1.54-2.58; p < 0.001). Interpretation: Durations of SAB were dependent on methicillin resistance and the primary foci of infection. The newly-defined persistent SAB is independently associated with in-hospital mortality. Funding: Seoul National University Bundang Hospital Research Fund. Declaration of Interest: None to declare. Ethical Approval: The analyses of cases from April 2015 to February 2018 were approved by the institutional review board of Seoul National University Bundang Hospital (IRB No. B-1801-442-102).

Direct Detection and Quantification of Bacterial Cell-free DNA in Patients with Bloodstream Infection (BSI) Using the Karius Plasma Next Generation Sequencing (NGS) Test

BackgroundBlood cultures can have low sensitivity if a patient is pretreated with antibiotics. A molecular diagnostic for bloodstream infection (BSI) that can also quantitate pathogen DNA could be a useful tool in detecting and monitoring culture-negative infections.MethodsWe prospectively enrolled 75 patients (50 with culture confirmed BSI due to Staphylococcus aureus [n = 21] or Gram-negative bacilli [n = 29] at baseline, and 25 with negative blood cultures) to evaluate the Karius plasma next generation sequencing (NGS) test to detect BSI. Blood samples from patients with confirmed BSI were collected for the study within one day of positive blood culture and then every 2–3 days. Cell-free DNA (cfDNA) was extracted from plasma and underwent NGS in the Karius CLIA/CAP laboratory (Redwood City, CA). After removal of human sequences, remaining reads were aligned against a curated pathogen database. Organisms present at a significance-level above a predefined threshold were reported. Quantity of cfDNA for each reported pathogen was expressed as molecules per microliter (MPM).ResultsWhen compared with baseline blood culture, the plasma NGS test had a positive agreement of 80% (40/50) and negative agreement of 84% (21/25). Overall, serially collected samples were positive by plasma NGS testing significantly longer than blood culture (mean 6.0 days vs. 2.4 days, respectively; P < 0.0001. Figure). Patients with BSI were positive longer by NGS testing than blood culture for both S. aureus (mean 6.9 days vs. 4.0 days, respectively; P < 0.005) and gram-negative bacilli (mean 5.4 days vs. 1.3 days, respectively; P < 0.001). Pathogen cfDNA in BSI patients, quantified as MPM, declined over time during treatment. S. aureus MPM declined more slowly than gram-negative MPM and was significantly higher than gram-negative MPM at day 6 (P < 0.001).ConclusionThe Karius plasma NGS test can directly detect pathogens in patients with BSI. Pathogen cfDNA signal in plasma remains positive longer than blood culture and combined with quantification of pathogen cfDNA, could be a useful biomarker to aid in diagnosis and monitoring of infections, particularly in those with sterile blood cultures.Disclosures L. Wanda, Karius, Inc: Collaborator and Employee, Salary; F. Ruffin, Karius, Inc.: Collaborator and Research Contractor, Salary; J. Hill-Rorie, Karius, Inc: Collaborator, Research support and Salary; D. Hollemon, Karius, Inc: Employee, Salary; H. Seng, Karius, Inc: Employee, Salary; D. Hong, Karius, Inc.: Employee, Salary; T. Blauwkamp, Karius, Inc: Employee, Salary; M. Kertesz, Karius, Inc: Employee, Salary; V. Fowler Jr., Karius, Inc: Grant Investigator, Grant recipient Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy, Janssen, xBiotech, Contrafect: Consultant, Consulting fee NIH, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Basilea; Contrafect; Karius: Grant Investigator, Grant recipient Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm: Consultant, Consulting fee UpToDate: Royalties, Royalties

Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults

Staphylococcus aureus bacteraemia (SAB) is a common, serious infection that is associated with high rates of morbidity and mortality. Evidence suggests that infectious disease consultation (IDC) improves clinical management in patients with SAB. We examined whether the introduction of a routine bedside IDC service for adults with SAB improved clinical management and outcomes compared to telephone consultation. We conducted an observational cohort study of 571 adults with SAB at a teaching hospital in the United Kingdom between July 2006 and December 2012. A telephone consultation was provided on the day of positive blood culture in all cases, but an additional bedside IDC was provided after November 2009 (routine IDC group). Compared to patients in the pre-IDC group, those in the routine IDC group were more likely to have a removable focus of infection identified, echocardiography performed and follow-up blood cultures performed. They also received longer courses of antimicrobial therapy, were more likely to receive combination antimicrobial therapy and were more likely to have SAB recorded in the hospital discharge summary. There was a trend towards lower mortality at 30 days in the routine IDC group compared to the pre-IDC group (12% vs. 22%, p 0.07). Our findings suggest that routine bedside IDC should become the standard of care for adults with SAB.

Improved outcome with early rifampicin combination treatment in methicillin-sensitive Staphylococcus aureus bacteraemia with a deep infection focus - a retrospective cohort study.

IntroductionRifampicin has been used as adjunctive therapy in Staphylococcus aureus bacteraemia (SAB) with a deep infection focus. However, data for prognostic impact of rifampicin therapy is unestablished including the optimal initiation time point. We studied the impact of rifampicin therapy and the optimal initiation time for rifampicin treatment on prognosis in methicillin-sensitive S. aureus bacteraemia with a deep infection.MethodsRetrospective, multicentre study in Finland including 357 SAB patients with a deep infection focus. Patients with alcoholism, liver disease or patients who died within 3 days were excluded. Patients were categorised according to duration of rifampicin therapy and according to whether rifampicin was initiated early (within 7 days) or late (7 days after) after the positive blood cultures. Primary end point was 90 days mortality.ResultsTwenty-seven percent of patients received no rifampicin therapy, 14% received rifampicin for 1-13 days whereas 59% received rifampicin ≥14 days. The 90 day mortality was; 26% for patients treated without rifampicin, 16% for rifampicin therapy of any length and 10% for early onset rifampicin therapy ≥14 days. Lack of rifampicin therapy increased (OR 1.89, p=0.026), rifampicin of any duration decreased (OR 0.53, p=0.026) and rifampicin therapy ≥14 days with early onset lowered the risk for a fatal outcome (OR 0.33, p<0.01) during 90 days follow-up.ConclusionRifampicin adjunctive therapy for at least 14 days and initiated within 7 days of positive blood culture associated with improved outcome among SAB patients with a deep infection.

Detection of Ica gene in Staphylococcus epidermidis for ability of biofilm formation with PCR methods

Background: Biomarkers for the prognosis in severe illness are ommonlyused.Meanplatelet volume (MPV) is an easily accessible aematological parameter which may reflect platelet activation as ell as endothelial damage. There areonly a fewreports concerning he use of this parameter as a biomarker in severe illness. Purpose of the study was the evaluation of MPV as a prognostic iomarker in patients with sepsis. Methods: Patients with suspected sepsis attending the Infecious Diseases wards, medical ICU or interdisciplinary anesthesilogy ICU were prospectively enrolled in the analysis. Measures ncluded demographics, medical history as well as clinical and aboratory biomarker determinations on admission and/or first ymprtomatic day and day of positive blood culture. Patients were ollowed having outcomes and biomarkers assessed in the course. Results: 183 patients (66 female) with confirmed sepsis were vailable for the analysis. Median age was 71 years (range 21-97 ears), median BMI was 26.3 kg/m2. All had at least one premorid medical conditions, more than two third had >3 significant re-existing diseases. Bacteria most commonly detected were S. ureus (54/183) and E. coli (39/183) reflecting the origin of sepis whichmostly were device-related and endocarditis (in 37/183), rogenital (in35/183)or skin, soft-tissuesandbone/joints (27/183), espectively. Unfavourable outcomes (death) at day 30 had 27/183 14.8%). Patients who died had a higher MPV at admission comared to the survivors (9.6 vs. 9.19 fl, p =0.031) which increased to n MPV of 11.2 vs. 9.7 fl (p=0.008) at the time of positive blood ulture drawn. Only mean arterial pressure (MAP) at the detecion of bacteremia (p=0.02) and thrombocyte count at bacteremia p=0.033) had significant associationswith death. Neither temperture, leukocytes, lactate, PCTorCrPhadsignificant associations (all > 0.1). Receiver operator curve showed AUC forMPV at admission f 0.71 and MPV at bacteremia of 0.68. MAP and thrombocytes at acteremia had much lower AUC (0.39 and 0.36, respectively). Conclusion: These preliminary data confirm the potential useulness of MPV as an easily accessible prognostic marker in sepsis. urther studies are required to confirm our results.

Bacteremic Streptococcus bovis infections at a university hospital, 1992-2001.

The association of Streptococcus bovis biotypes with types of clinical infection and underlying malignancies has rarely been reported in Taiwan. The aim of this study was to characterize the clinical features and microbiological characteristics of patients with S. bovis bacteremia. From January 1992 to December 2001, 62 patients with S. bovis bacteremia were treated at National Taiwan University Hospital. Their demographic characteristics, clinical features, results of imaging studies, pathological findings, and laboratory data were retrospectively analyzed. Antimicrobial susceptibilities were determined using the agar dilution method and biotypes were determined using the API 20 Strep system. The majority of cases (76%) occurred during the 1996-1997 and 1999-2000 periods. Thirty five patients were male, and the mean age of the 62 patients was 61 years. Underlying diseases included malignancies (40%), cardiac diseases (27%), diabetes mellitus (24%), and liver cirrhosis (21%). Fifty two percent (n = 32) of patients presented with primary bacteremia and 24% (15) with definite or possible infective endocarditis. Thirteen percent (8) presented with hepatobiliary infections (acute cholecystitis and biliary tract infection). Ten patients (16%) had polymicrobial bacteremia. All of the concomitant pathogen(s) were Gram-negative rods, among which Escherichia coli predominated. The mortality rate on day 30 of illness was 21%. High Acute Physiology and Chronic Health Evaluation (APACHE) II score on the day of positive blood culture was associated with high mortality. Among the 19 patients (31%) who underwent colonoscopy, 9 (47%) had colonic lesions (tubular adenomas or carcinomas). Of the 26 patients (41%) who underwent echocardiography, 14 (54%) had vegetation in the valves. Of the 47 S. bovis isolates examined for biotypes, 37 (79%) were biotype II (29 of biotype II/2 and 8 of biotype II/1) and 10 (21%) were biotype I. The majority of isolates causing primary bacteremia (92%), hepatobiliary infections (100%) and primary bacterial peritonitis (100%) were biotype II, while 67% of isolates associated with infective endocarditis were biotype I. All isolates were susceptible to penicillin. Infective endocarditis should be highly suspected in patients with bacteremia due to S. bovis biotype I. Investigations for intra-abdominal foci other than the colon should be undertaken in patients with bacteremia caused by S. bovis biotype II. Due to the increasing number of S. bovis bacteremia patients at the hospital and unknown origins of about 50% of bacteremia cases, the need for colonoscopy and echocardiography in each case and biotyping of each blood isolate should be emphasized.

Normal Leukocyte Counts in Staphylococcus aureus Septicaemia

Staphylococcus aureus septicaemia is still a serious disease with a high mortality. The absence of leukocytosis in serious bacterial infections is generally considered as an unfavourable prognostic sign. The leukocyte pattern in 75 patients with S. aureus septicaemia was reviewed retrospectively. In the 66 patients where leukocyte determinations were done within 2 days of positive blood culture, 21 presented without leukocytosis which contrasts to only 1/35 patients with Escherichia coli septicaemia studied as controls (p less than 0.001). During follow up of S. aureus septicaemia only 5 of the patients developed leukocytosis greater than 10 x 10(9)/l and 2 leukopenia. There was no significant difference in mortality in patients without initial leukocytosis (14%) compared to patients with initial leukocytosis (24%). Except for septic arthritis, which was associated significantly more often with leukocytosis, complications were found with about the same frequency in both groups. Thus absence of leukocytosis seems not be an unfavourable prognostic sign in S. aureus septicaemia.