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The reply
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methicillin-resistant S. aureus infections. After all, the retrospective review revealed that 11 of 14 patients with S. aureus bacteremia did receive appropriate empiric antimicrobial therapy. JORDAN B. GLASER, M.D. MARK DICHTER, M.D. The Staten Island Hospital Staten Island, New York Submitted April 20, 1989, and accepted December 11, 1989
The Reply:
We appreciate the interest generated by our article on bloodstream infections in the elderly, and respond to the questions raised by Drs. Glaser and Dichter. The clinical histories and laboratory data were not sufficient for predicting which patients had S.
aureus bacteremia. None of the six
p a t i e n t s c i t e d in G l a s e r and Dichter's letter had diabetes mellitus or postinfluenzal pneumonia; we did not test for deficits of polymorphonuclear leukocyte function. For the eight patients with nosocomial bacteremia, an intravascular device was in place and suspected as the source in only two. One of two patients with pneumonia had S. aureus isolated from sputum culture; one of four wounds in patients with vascular grafts and/or wound infections was also positive. Gram stains were not available for evaluation. During the time period of this study, there was no known problem with methicillin-resistant S. aureus at this hospital; data were unavailable from the nursing homes
where some of these patients resided. For the one patient with a methicillin-resistaut S. aureus isolate, appropriate therapy with vancomycm was given. On the basis of the analysis of the data we presented in our report, we do not believe that clinical history, laboratory data, and knowledge of resistance patterns are sufficient to predict which patients will have bacteremia due to S. aureus versus other microorganisms. B. R. METERS, M.D. E. SHERMAN, M.D. M.H. MENDELSON, M.D. G. VELASQUEZ, M.D. E. SRULEVITCH-CHIN M. HUBBARD, Ph.D. S. Z. HIRSCHMAN, M.D. The Mount Sinai Medical Center New York, New York
May 1990 The American Journal of Medicine Volume88
555
methicillin-resistant S. aureus infections. After all, the retrospective review revealed that 11 of 14 patients with S. aureus bacteremia did receive appropriate empiric antimicrobial therapy. JORDAN B. GLASER, M.D. MARK DICHTER, M.D. The Staten Island Hospital Staten Island, New York Submitted April 20, 1989, and accepted December 11, 1989
The Reply:
We appreciate the interest generated by our article on bloodstream infections in the elderly, and respond to the questions raised by Drs. Glaser and Dichter. The clinical histories and laboratory data were not sufficient for predicting which patients had S.
aureus bacteremia. None of the six
p a t i e n t s c i t e d in G l a s e r and Dichter's letter had diabetes mellitus or postinfluenzal pneumonia; we did not test for deficits of polymorphonuclear leukocyte function. For the eight patients with nosocomial bacteremia, an intravascular device was in place and suspected as the source in only two. One of two patients with pneumonia had S. aureus isolated from sputum culture; one of four wounds in patients with vascular grafts and/or wound infections was also positive. Gram stains were not available for evaluation. During the time period of this study, there was no known problem with methicillin-resistant S. aureus at this hospital; data were unavailable from the nursing homes
where some of these patients resided. For the one patient with a methicillin-resistaut S. aureus isolate, appropriate therapy with vancomycm was given. On the basis of the analysis of the data we presented in our report, we do not believe that clinical history, laboratory data, and knowledge of resistance patterns are sufficient to predict which patients will have bacteremia due to S. aureus versus other microorganisms. B. R. METERS, M.D. E. SHERMAN, M.D. M.H. MENDELSON, M.D. G. VELASQUEZ, M.D. E. SRULEVITCH-CHIN M. HUBBARD, Ph.D. S. Z. HIRSCHMAN, M.D. The Mount Sinai Medical Center New York, New York
May 1990 The American Journal of Medicine Volume88
555