Abstract
Introduction
Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates.
Methods
We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988–1994 (342 patients), 1998–2004 (597 patients) and 2005–2010 (753 patients).
Results
In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005–2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005–2010.
Conclusions
In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.
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References
Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014;312:1330–41.
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.
Frimodt-Moller N, Espersen F, Skinhoj P, Rosdahl VT. Epidemiology of Staphylococcus aureus bacteremia in Denmark from 1957 to 1990. Clin Microbiol Infect. 1997;3:297–305.
Mejer N, Westh H, Schonheyder HC, Jensen AG, Larsen AR, Skov R, et al. Stable incidence and continued improvement in short term mortality of Staphylococcus aureus bacteraemia between 1995 and 2008. BMC Infect Dis. 2012;12:260.
David MZ, Daum RS, Bayer AS, Chambers HF, Fowler VG Jr, Miller LG, et al. Staphylococcus aureus bacteremia at 5 US academic medical centers, 2008–2011: significant geographic variation in community-onset infections. Clin Infect Dis. 2014;59:798–807.
Rhee Y, Aroutcheva A, Hota B, Weinstein RA, Popovich KJ. Evolving epidemiology of Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2015;36:1417–22.
Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015;28:603–61.
Asgeirsson H, Gudlaugsson O, Kristinsson KG, Heiddal S, Kristjansson M. Staphylococcus aureus bacteraemia in Iceland, 1995–2008: changing incidence and mortality. Clin Microbiol Infect. 2011;17:513–8.
Benfield T, Espersen F, Frimodt-Moller N, Jensen AG, Larsen AR, Pallesen LV, 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.
Paul M, Kariv G, Goldberg E, Raskin M, Shaked H, Hazzan R, et al. Importance of appropriate empirical antibiotic therapy for methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother. 2010;65:2658–65.
Paul M, Zemer-Wassercug N, Talker O, Lishtzinsky Y, Lev B, Samra Z, et al. Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia? Clin Microbiol Infect. 2011;17:1581–6.
Allard C, Carignan A, Bergevin M, Boulais I, Tremblay V, Robichaud P, 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.
Smit J, Sogaard M, Schonheyder HC, Nielsen H, Thomsen RW. Classification of healthcare-associated Staphylococcus aureus bacteremia: influence of different definitions on prevalence, patient characteristics, and outcome. Infect Control Hosp Epidemiol. 2016;37(2):208–11.
Bishara J, Pitlik S, Samra Z, Levy I, Paul M, Leibovici L. Co-trimoxazole-sensitive, methicillin-resistant Staphylococcus aureus, Israel, 1988–1997. Emerg Infect Dis. 2003;9:1168–9.
Trzcinski K, Cooper BS, Hryniewicz W, Dowson CG. Expression of resistance to tetracyclines in strains of methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 2000;45:763–70.
Aubry-Damon H, Legrand P, Brun-Buisson C, Astier A, Soussy CJ, Leclercq R. Reemergence of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus: roles of an infection control program and changes in aminoglycoside use. Clin Infect Dis. 1997;25:647–53.
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Yahav, D., Shaked, H., Goldberg, E. et al. Time trends in Staphylococcus aureus bacteremia, 1988–2010, in a tertiary center with high methicillin resistance rates. Infection 45, 51–57 (2017). https://doi.org/10.1007/s15010-016-0919-6
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DOI: https://doi.org/10.1007/s15010-016-0919-6