Skip to main content

Advertisement

SpringerLink
Log in

Epidemiology and Outcome Determinants of Staphylococcus aureus Bacteremia Revisited: A Population-Based Study

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. We sought to re-define the burden, epidemiology and mortality-associated risk factors of SAB in a large Canadian health region.

Methods

Residents (> 18 years) experiencing SAB from 2012 to 2014 were assessed. Incidence rates were calculated using civic census results. Factors associated with 30-day mortality were determined through multivariate logistic regression. Incidence and risk factors for SAB were compared to 2000–2006 data.

Results

780 residents experienced 840 episodes of SAB (MRSA; 20%). Incidence rates increased from 23.5 to 32.0 cases/100,000 from 2012 to 2014; [IRR 1.15 (95% CI 1.07–1.23); p < 0.001]. Compared to a decade ago, incidence of SAB has increased [IRR 1.28 (95% CI 1.21–1.36); p < 0.001] despite minimal change in nosocomial SAB. MRSA proportion did not change through the study (p = 0.3), but did increase relative to a decade ago (20.0% vs 11.0%, p < 0.001). Thirty-day mortality rates were 30.6% and 21.3% for MRSA and MSSA, respectively (p = 0.01), similar to rates from 2000 to 2006. Several clinical, demographic, and biochemical factors were independently associated with SAB mortality.

Conclusions

SAB is common within our population resulting in significant mortality. Incidence rates of SAB are increasing in our health region; however, 30-day mortality rates remain stable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Laupland KB, Lyytikäinen O, Søgaard M, et al. The changing epidemiology of Staphylococcus aureus bloodstream infection: a multinational population-based surveillance study. Clin Microbiol Infect. 2013;19:465–71.

    Article  CAS  Google Scholar 

  2. Public Health England: Staphylococcus aureus (MRSA and MSSA) bacteraemia mandatory reports 2016/17. United Kingdom.

  3. Allard C, Carignan A, Bergevin M, et al. Secular changes in incidence and mortality associated with Staphylococcus aureus bacteraemia in Quebec, Canada, 1991–2005. Clin Microbiol Infect. 2008;14:421–8.

    Article  CAS  Google Scholar 

  4. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010;23:616–87.

    Article  CAS  Google Scholar 

  5. Liu C, Graber CJ, Karr M, et al. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-2005. Clin Infect Dis. 2008;46:1637–46.

    Article  CAS  Google Scholar 

  6. van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev. 2012;25:362–86.

    Article  Google Scholar 

  7. Whitby M, McLaws ML, Berry G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust. 2001;175:264–7.

    Article  CAS  Google Scholar 

  8. Laupland KB, Ross T, Gregson DB. Staphylococcus aureus bloodstream infections: risk factors, outcomes, and the influence of methicillin resistance in Calgary, Canada, 2000–2006. J Infect Dis. 2008;198:336–43.

    Article  Google Scholar 

  9. Alberta Health Services Annual Report 2015-2016: Alberta Health Services.

  10. The City of Calgary—Past census results. Available at: http://www.calgary.ca/CA/city-clerks/Pages/Election-and-Information-Services/Civic-Census/CensusResults.aspx. Accessed October 11 2018.

  11. Performance Standards for Antimicrobial Susceptibility Testing. Supplement M100. Wayne: Clincal and Laboratory Standards Institute; 2017.

    Google Scholar 

  12. Friedman ND, Kaye KS, Stout JE, et al. Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137:791–7.

    Article  Google Scholar 

  13. Lenz R, Leal JR, Church DL, Gregson DB, Ross T, Laupland KB. The distinct category of healthcare associated bloodstream infections. BMC Infect Dis. 2012;12:85.

    Article  Google Scholar 

  14. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8.

    Article  CAS  Google Scholar 

  15. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious diseases Society of America. Clin Infect Dis. 2009;49:1–45.

    Article  CAS  Google Scholar 

  16. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.

    Article  CAS  Google Scholar 

  17. Stokes W, Parkins MD, Parfitt ECT, Ruiz JC, Mugford G, Gregson DB. Incidence and outcomes of Staphylococcus aureus bacteriuria: a population-based study. Clin Infect Dis. 2018;3:1.

    Google Scholar 

  18. The City of Calgary—Past census results. Available at: http://www.calgary.ca/CA/city-clerks/Pages/Election-and-Information-Services/Civic-Census/CensusResults.aspx. Accessed October 11, 2018 2018.

  19. Services AH. Available at: https://www.albertahealthservices.ca/about/calgaryzone.aspx. Accessed December 20 2018.

  20. Laupland KB, Church DL, Mucenski M, Sutherland LR, Davies HD. Population-based study of the epidemiology of and the risk factors for invasive Staphylococcus aureus infections. J Infect Dis. 2003;187:1452–9.

    Article  Google Scholar 

  21. Rhodes D, Cheng AC, McLellan S, et al. Reducing Staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae: successful implementation of a care bundle at a large Australian health service. J Hosp Infect. 2016;94:86–91.

    Article  CAS  Google Scholar 

  22. Freixas N, Bella F, Limón E, Pujol M, Almirante B, Gudiol F. Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study. Clin Microbiol Infect. 2013;19:838–44.

    Article  CAS  Google Scholar 

  23. Taylor G, Bush K, Leal J, Henderson E, Chui L, Louie M. Epidemiology of meticillin-resistant Staphylococcus aureus bloodstream infections in Alberta, Canada. J Hosp Infect. 2015;89:132–5.

    Article  CAS  Google Scholar 

  24. Jokinen E, Laine J, Huttunen R, et al. Trends in incidence and resistance patterns of Staphylococcus aureus bacteremia. Infect Dis (Lond). 2018;50:52–8.

    Article  CAS  Google Scholar 

  25. Jaganath D, Jorakate P, Makprasert S, et al. Bacteremia incidence and methicillin resistance in rural Thailand, 2006–2014. Am J Trop Med Hyg. 2018;99:155–63.

    Article  Google Scholar 

  26. Renaud A, Lavigne M, Vendittoli PA. Periprosthetic joint infections at a teaching hospital in 1990–2007. Can J Surg. 2012;55:394–400.

    Article  Google Scholar 

  27. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271:1598–601.

    Article  CAS  Google Scholar 

  28. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003;36:53–9.

    Article  Google Scholar 

  29. Yaw LK, Robinson JO, Ho KM. A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia: an observational cohort study. Lancet Infect Dis. 2014;14:967–75.

    Article  Google Scholar 

  30. Lam J, Robinson S, Gregson D, et al. Staphylococcus aureus bacteremia (SAB) management in a large metropolitan integrated health region: quality of care determinants (QoCD). In: ID Week. (San Diego, California). Open Forum Infectious Diseases pp S557–S8.

  31. Bai AD, Showler A, Burry L, et al. Impact of infectious disease consultation on quality of care, mortality, and length of stay in Staphylococcus aureus bacteremia: results from a large multicenter cohort study. Clin Infect Dis. 2015;60:1451–61.

    Article  Google Scholar 

  32. Lam JC, Gregson DB, Robinson S, et al. Infectious diseases consultation improves key performance metrics in the management of Staphylococcus aureus bacteremia: a multicentre cohort study. J Assoc Med Microbiol Infect Dis Canada. 2019;4:24–32.

    Google Scholar 

  33. Hanses F, Spaeth C, Ehrenstein BP, Linde HJ, Schölmerich J, Salzberger B. Risk factors associated with long-term prognosis of patients with Staphylococcus aureus bacteremia. Infection. 2010;38:465–70.

    Article  CAS  Google Scholar 

  34. Benfield T, Espersen F, Frimodt-Møller N, et al. Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000. Clin Microbiol Infect. 2007;13:257–63.

    Article  CAS  Google Scholar 

  35. Kaye MG, Fox MJ, Bartlett JG, Braman SS, Glassroth J. The clinical spectrum of Staphylococcus aureus pulmonary infection. Chest. 1990;97:788–92.

    Article  CAS  Google Scholar 

  36. Magret M, Lisboa T, Martin-Loeches I, et al. Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study. Crit Care. 2011;15:R62.

    Article  Google Scholar 

  37. Chen SY, Wang JT, Chen TH, et al. Impact of traditional hospital strain of methicillin-resistant Staphylococcus aureus (MRSA) and community strain of MRSA on mortality in patients with community-onset S aureus bacteremia. Medicine (Baltimore). 2010;89:285–94.

    Article  CAS  Google Scholar 

  38. Kang CI, Song JH, Chung DR, et al. Clinical impact of methicillin resistance on outcome of patients with Staphylococcus aureus infection: a stratified analysis according to underlying diseases and sites of infection in a large prospective cohort. J Infect. 2010;61:299–306.

    Article  Google Scholar 

  39. Holmes NE, Turnidge JD, Munckhof WJ, et al. Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high vancomycin minimum inhibitory concentrations. J Infect Dis. 2011;204:340–7.

    Article  CAS  Google Scholar 

  40. Turnidge JD, Kotsanas D, Munckhof W, et al. Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand. Med J Aust. 2009;191:368–73.

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Author information

Authors and Affiliations

  1. Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    John C. Lam

  2. Departments of Medicine and Pathology and Laboratory Medicine, Calgary Laboratory Services, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Daniel B. Gregson

  3. Department of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada

    Stephen Robinson

  4. Departments of Medicine and Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Ranjani Somayaji & Michael D. Parkins

  5. Departments of Medicine, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    John M. Conly

Authors
  1. John C. Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel B. Gregson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ranjani Somayaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John M. Conly
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael D. Parkins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael D. Parkins.

Ethics declarations

Conflict of interest

All authors declare that they do not have any conflict of interest relevant to this manuscript.

Presented in part

Association of Medical Microbiology and Infectious Disease Conference 2018, Vancouver, BC. Abstract SP 44.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lam, J.C., Gregson, D.B., Robinson, S. et al. Epidemiology and Outcome Determinants of Staphylococcus aureus Bacteremia Revisited: A Population-Based Study. Infection 47, 961–971 (2019). https://doi.org/10.1007/s15010-019-01330-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-019-01330-5

Keywords

Search

Navigation