, 114 episodes of Staphylococcus aureus bacteremia (SAB) were identified in 111 patients at the Buffalo Veterans Administration Medical Center. Only 14% of the episodes were community-acquired, and 29% were due to methicillin-resistant strains. The commonest foci of SAB were intravascular catheters (33%), postoperative wounds (11%), skin infections (7%), and pulmonary infections (7%o). Complications were infrequent, with endocarditis in two patients and metastatic infection in one. Mortality due to SAB was 32%, with no difference in mortality between communityacquired and hospital-acquired SAB. Although not statistically significant, there was a trend of higher mortality for methicillin-resistant SAB (42%0) than for methicillin-sensitive SAB (28%o) and for patients with no focus of SAB (43%) than for those with a defined primary focus (28%). A review of studies of SAB published since 1940 revealed several trends. SAB is now predominately a nosocomial infection; intravascular-catheter infection has become the commonest cause of SAB; with several exceptions, the risk of endocarditis in patients with SAB is low (50/-20%0); mortality due to SAB has decreased over the past 40 years but not over the past 10 years. Staphylococcus aureus was recently characterized by Sheagren [1] as the "persistent pathogen." Despite the availability of potent antistaphylococcal antibiotics, infection due to S. aureus continues to cause considerable morbidity and mortality [2-4]. The most serious result of infection is S. aureus bacteremia (SAB). Since 1940 many studies have been published dealing with SAB in general hospital populations [5-25]. Only three of these studies [18, 19, 21] were performed prospectively. In one of these studies [19], which was performed by one of us (J. M. M.), 49 consecutive episodes of SAB were followed at two hospitals. Although this study provided useful information, the number of patients evaluated was relatively small and the findings may not have necessarily represented the overall picture of SAB at either hospital. In the current study the results of a 30-month

A retrospective review of microbiology records revealed 19 documented episodes of M. morganii bacteremia in 18 patients at a Veterans Administration hospital during a 5.5 year period. Thirteen of 19 bacteremias were related to nosocomial infections; 11 of the 13 nosocomial bacteremias occurred in surgical patients. Nine of the 13 patients with nosocomial bacteremia had received recent therapy with a beta-lactam antibiotic. The most common source of bacteremia was a postoperative wound infection (seven episodes). Only one episode was related to a urinary tract infection.Retrospective analysis showed that clusters of cases of M. morganii bacteremia had occurred almost yearly. This finding prompted a six-month period of prospective monitoring of all cultures for M. morganii to identify human reservoirs in our institution. Sixty percent of all cultures growing M. morganii came from urine cultures, 18% came from wound cultures, and the remaining 22% came from a variety of body fluids or tube drainage. Thirty-one percent of patients harboring M. morganii were on the Surgical Service.M. morganii bacteremia most commonly occurs in postoperative patients who receive beta-lactam antibiotics. From the data in this study, M. morganii is an infrequent cause of bacteremia, and its presence in blood cultures may be an indicator of an environment conducive for an outbreak of nosocomial infection.

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