In multivariate analysis, primary bacteremia was associated with a trend toward increased treatment failure (P ‫؍‬ 0.06). Therefore, in the treatment of uncomplicated SAB, it seems reasonable to consider at least 14 days of antibiotic therapy to prevent relapse, as practice guidelines recommend. Because of its poor prognosis, primary bacteremia, even with a low risk of complication, should not be treated with short-course therapy.

Background Pleural empyema is a well known complication of pneumonia. Attitudes differ, however, about the best treatment of this condition and the place of drainage, early operation, and local antibiotics. Methods In a retrospective study 94 consecutive patients with verified empyema caused by pneumonia were admitted to the department of either pulmonary medicine or thoracic surgery. Treatment was either by a lavage regimen (daily thoracocentesis, saline rinse, systemic antibiotics, and in some patients instillation of local antibiotics) in the medical ward (51 patients) or by tube drainage and systemic antibiotics in the surgical unit (43 patients). Results The stay in hospital was significantly shorter in the medically treated patients than in the surgical group-2 3 v 5 0 weeks respectively. Furthermore, pleurocutaneous and bronchopleural fistulas developed more frequently in patients treated by tube drainage than in those treated with the thoracocentesis regimen alone (13 (30%) v 5 (10%) and 6 (14%) v 2 (4%) for each complication respectively). The overall mortality was 8-5%, with no differences between treatments.Conclusions Treatment with a lavage regimen plus local and systemic antibiotics seems to be associated with a lower frequency of complications and a shorter duration of hospital stay than tube drainage and systemic antibiotics. These results should be confirmed by a prospective, randomised study.

Patients with liver cirrhosis (LC) have impaired immunity and thus are predisposed to infections. Few studies have attempted to evaluate Staphylococcus aureus bacteremia (SAB) in LC patients. Therefore, this study prospectively evaluated the clinical characteristics and outcomes of 642 episodes of SAB from August 1, 2008 to September 31, 2010. Of 642 patients with SAB, 109 (17.0 %) were classified as LC patients whereas the remaining 533 (83.0 %) were classified as non-LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (32 % vs. 22 %, respectively; P = 0.047). The 30-day mortality rates of patients with MSSA bacteremia and MRSA bacteremia were not significantly different among LC patients (35.1 % with MSSA vs. 26.9 % with MRSA; P = 0.41). A univariate analysis of the 30-day mortality rate of LC patients with SAB for survivors and non-survivors showed that rapidly fatal or ultimately fatal according to the criteria of McCabe and Jackson (OR 5.0; 95 % CI 1.60-15.65), septic shock at initial presentation (OR 3.5; 95 % CI 1.18-10.39) and Child-Pugh class C (OR 2.8; 95 % CI 1.20-6.59) were associated with increased mortality. In contrast, the removal of the eradicable focus was associated with decreased mortality (OR 0.14; 95 % CI 0.04-0.52). Disease severity and liver dysfunction may be useful for predicting the prognosis of SAB in LC patients.