Chest
Volume 97, Issue 4, April 1990, Pages 788-792
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Clinical Investigations
The Clinical Spectrum of Staphylococcus aureus Pulmonary Infection

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Staphylococcus aureus causes serious pulmonary infections in adults. Prior descriptions of this entity have depended on diagnosis of expectorated sputum cultures that are often contaminated. To better characterize this infection, we retrospectively reviewed the medical records of 31 adults with S aureus pulmonary infection diagnosed by culture specimens uncontaminated by the upper respiratory flora. Our results support the concept that S aureus pulmonary infections usually occur in older adults (sixth decade or older) with concomitant illnesses that are typically nosocomial. However, in contrast to previous reports, the chest roentgenograms in these patients typically showed multilobar infiltrates (60 percent), predominantly in the lower lobes (64 percent), and often bilateral (48 percent). Pleural involvement (48 percent) was more common than previously reported, and abscess formation (16 percent) occurred infrequently. Sputum cultures were found to be sensitive but nonspecific diagnostic tools. Despite antibiotic therapy, reinfection occurred in 10 percent of patients and the mortality rate was 32 percent.

Section snippets

Materials and Methods

We reviewed the case records of 31 adults who had the diagnosis of S aureus pneumonia, empyema, or lung abscess. Patients were identified by computerized searches of records of microbiology and medical records departments at the Rhode Island Hospital, Boston City Hospital, and Boston VA Hospital over a six-year period.

Patients were included in the study if they met the following criteria: (1) The lung was the primary source of infection (patients with clinical evidence of endocarditis, an

Patient Profile

The patient demographics are summarized in Table 1. This study included 31 patients whose ages ranged from 26 to 83 years old (median = 61 years). Twenty-seven (87 percent) of 31 patients were older than 50 years old. Almost all of the patients had at least one major underlying medical condition, and 21 (68 percent) of 31 patients had underlying pulmonary disease, the most prevalent of which was chronic bronchitis or emphysema (14 patients). Influenza was the underlying illness in two patients,

Discussion

The first and largest study of S aureus pneumonia in adults was published by Chickering and Park12 in 1919, in the wake of the 1918 influenza epidemic. At Camp Jackson, South Carolina, 8,100 soldiers contracted influenza, which was complicated by pneumonia in 1,409 soldiers; 385 died. Postmortem lung cultures were obtained from 312 soldiers and 153 were identified as S aureus. The authors noted that “the striking features of the disease are peculiar cherry-red indigo-blue cyanosis, the

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    Manuscript received June 28; revision accepted September 12.

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