TY - JOUR
T1 - Decreasing incidence of Staphylococcus aureus bacteremia over 9 years
T2 - Greatest decline in community-associated methicillin-susceptible and hospital-acquired methicillin-resistant isolates
AU - Khatib, Riad
AU - Sharma, Mamta
AU - Iyer, Sugantha
AU - Fakih, Mohamad G.
AU - Obeid, Karam M.
AU - Venugopal, Anilrudh
AU - Fishbain, Joel
AU - Johnson, Leonard B.
AU - Segireddy, Madhuri
AU - Jose, Jinson
AU - Riederer, Kathleen
N1 - Funding Information:
Supported by the St John Hospital Medical Education Fund .
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/3
Y1 - 2013/3
N2 - Background: The impact of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) emergence on the epidemiology of S aureus bacteremia (SAB) is not well documented. Methods: This was an observational study of adult (aged ≥18 years) inpatients with SAB in a single 808-bed teaching hospital during 2002-2003, 2005-2006, 2008-2009, and 2010 with period-stratified SAB rate, onset mode, patient characteristics, and outcome. Results: We encountered a total of 1,098 cases over the entire study period. The rate decreased steadily over time (from 6.64/103 discharges in 2002-2003 to 6.49/103 in 2005-2006, 5.24/103 in 2008-2009, and 5.00/103 in 2010; P =.0001), with a greater decline in community-associated cases (0.99/103, 0.77/103, 0.58/103, and 0.40/103, respectively; P =.0005) compared with health care-associated cases (5.65/103, 5.72/103, 4.66/103, and 4.60/103, respectively; P =.005). The decline was principally in MSSA (3.11/103, 2.21/103, 2.24/103, and 1.75/103, respectively; P =.00006), including both community-associated (P = .0002) and health care-associated cases (P =.006). Although overall rate changes in MRSA were not significant (P =.09), hospital-onset MRSA decreased markedly (P <.00001), whereas CA-MRSA increased (P =.03). The all-cause 100-day mortality rate did not change significantly (25.6% for 2002-2003, 25.2% for 2005-2006, 28.1% for 2008-2009, and 32.2% for 2010; P =.10). Differences in MSSA/MRSA-associated mortality decreased (20.1% vs 30.6%, P =.03 for 2002-2003; 18.1% vs 28.9%, P =.05 for 2005-2006; 21.7% vs 32.9%, P =.05 for 2008-2009; and 29.3% vs 34.9, P =.5 for 2010). Conclusions: SAB incidence is decreasing, with the greatest decline in community-associated MSSA and hospital-onset MRSA cases. Most health care-associated cases currently are community-onset. MRSA/MSSA-related mortality is comparable. These changes are likely related to the emergence of CA-MRSA and the inpatient-to-outpatient shift in health care.
AB - Background: The impact of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) emergence on the epidemiology of S aureus bacteremia (SAB) is not well documented. Methods: This was an observational study of adult (aged ≥18 years) inpatients with SAB in a single 808-bed teaching hospital during 2002-2003, 2005-2006, 2008-2009, and 2010 with period-stratified SAB rate, onset mode, patient characteristics, and outcome. Results: We encountered a total of 1,098 cases over the entire study period. The rate decreased steadily over time (from 6.64/103 discharges in 2002-2003 to 6.49/103 in 2005-2006, 5.24/103 in 2008-2009, and 5.00/103 in 2010; P =.0001), with a greater decline in community-associated cases (0.99/103, 0.77/103, 0.58/103, and 0.40/103, respectively; P =.0005) compared with health care-associated cases (5.65/103, 5.72/103, 4.66/103, and 4.60/103, respectively; P =.005). The decline was principally in MSSA (3.11/103, 2.21/103, 2.24/103, and 1.75/103, respectively; P =.00006), including both community-associated (P = .0002) and health care-associated cases (P =.006). Although overall rate changes in MRSA were not significant (P =.09), hospital-onset MRSA decreased markedly (P <.00001), whereas CA-MRSA increased (P =.03). The all-cause 100-day mortality rate did not change significantly (25.6% for 2002-2003, 25.2% for 2005-2006, 28.1% for 2008-2009, and 32.2% for 2010; P =.10). Differences in MSSA/MRSA-associated mortality decreased (20.1% vs 30.6%, P =.03 for 2002-2003; 18.1% vs 28.9%, P =.05 for 2005-2006; 21.7% vs 32.9%, P =.05 for 2008-2009; and 29.3% vs 34.9, P =.5 for 2010). Conclusions: SAB incidence is decreasing, with the greatest decline in community-associated MSSA and hospital-onset MRSA cases. Most health care-associated cases currently are community-onset. MRSA/MSSA-related mortality is comparable. These changes are likely related to the emergence of CA-MRSA and the inpatient-to-outpatient shift in health care.
KW - Epidemiology
KW - MRSA
KW - MSSA
KW - Trends
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U2 - 10.1016/j.ajic.2012.03.038
DO - 10.1016/j.ajic.2012.03.038
M3 - Article
C2 - 23040608
AN - SCOPUS:84875368805
VL - 41
SP - 210
EP - 213
JO - American Journal of Infection Control
JF - American Journal of Infection Control
SN - 0196-6553
IS - 3
ER -