Since staphylococcus aureus bacteremia continues to be a common occurrence in patients with arteriovenous fistulas who are undergoing long-term hemodialysis, the complications and outcome of 37 episodes of bacteremia were examined. Systemic complications included pulmonary emboli, empyema, persistent bacteremia, and endocarditis. Such events were rarely life threatening--three of the 34 episodes involving patients without severe concurrent medical problems resulted in death. Local complications at the fistula site were common; however, thrombosis, hemorrhage, impending rupture, and persistent bacteremia caused loss of fistula in 13 of the 22 episodes seen with fistula inflammation. Results of this study demonstrate that, although loss of vascular access was an important problem, particularly in patients with prosthetic grafts, patients with S aureus bacteremia who were undergoing long-term hemodialysis had a favorable prognosis for survival, particularly when they were compared with other patients not undergoing hemodialysis.