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Population-based epidemiology of Staphylococcus aureus bloodstream infection: clonal complex 30 genotype is associated with mortality

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Abstract

Staphylococcus aureus bloodstream infections (SABSI) are associated with a high burden of morbidity and mortality. The impact of specific S. aureus genotypes on outcome is unclear. The aim of this study was to evaluate the epidemiology and outcome of SABSI, with a special emphasis on the impact of bacterial clonal lineage on mortality. We conducted a 3-year population-based prospective study between 2011 and 2014, including 303 consecutive adult patients. Clinical data were obtained from interviews and medical records. S. aureus isolates were genotyped using DNA microarrays. The incidence rate of SABSI was 27.6 per 100,000 inhabitants [95 % confidence interval (CI) 24.6–31.0]. The median age of the patients was 71 years (interquartile range 56–81 years) and 61.4 % were male. Most SABSI (70.6 %) occurred in hospitals or associated to healthcare, and 34.1 % of these were associated with intravascular catheters. Only five (1.6 %) SABSI were caused by methicillin-resistant S. aureus (MRSA). The 30-day case fatality rate was 20.8 % (95 % CI 16.6–25.7). S. aureus clonal complex 30 [hazard ratio (HR) 3.9; 95 % CI 1.8–8.5, p = 0.001], unknown focus of infection (HR 4.5; 95 % CI 1.9–10.8, p = 0.001) and respiratory tract infection (HR 12.7; 95 % CI 4.6–34.6, p < 0.001) were independent predictors of mortality in a Cox regression analysis after adjusting for age, sex and underlying conditions. A high proportion of potential preventable SABSI calls for effective infection control measures. S. aureus clonal complex 30 genotype was associated with mortality in patients with bloodstream infections. The genetic basis underlying this association remains to be demonstrated.

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Acknowledgements

We thank Karin Helmersen and colleagues at Akershus University Hospital, Department of Microbiology and Infection Control, for the technical assistance and infectious diseases specialist Margrethe Astrup for evaluating the clinical data. We thank Antje Ruppelt at the Medical Faculty Carl Gustav Carus, Dresden, Germany, for the technical assistance with the microarrays and Stefan Monecke at Alere Technologies GmbH, Jena, Germany, for the interpretation of the microarray results.

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Authors and Affiliations

  1. Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway

    A. Blomfeldt, H. V. Aamot & T. M. Leegaard

  2. Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway

    A. N. Eskesen

  3. Department of Clinical Molecular Biology (EpiGen), Akershus University Hospital and University of Oslo, Lørenskog, Norway

    H. V. Aamot

  4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    T. M. Leegaard

  5. Department of Infectious Diseases Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

    J. V. Bjørnholt

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  1. A. Blomfeldt
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  2. A. N. Eskesen
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  3. H. V. Aamot
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  4. T. M. Leegaard
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Correspondence to A. Blomfeldt.

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Funding

The study was supported by a Strategic Research grant (2619028/90003) from Akershus University Hospital.

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The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval was given by the Norwegian Regional Ethics Committee South-East (2009/2149-1) and by the Data Protection Official at Akershus University Hospital (2010-041).

Informed consent

Written informed consent was obtained from all individual participants included in the study, except for a small fraction of patients (n = 22) who died before an interview could be performed and consent could be asked for.

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Blomfeldt, A., Eskesen, A.N., Aamot, H.V. et al. Population-based epidemiology of Staphylococcus aureus bloodstream infection: clonal complex 30 genotype is associated with mortality. Eur J Clin Microbiol Infect Dis 35, 803–813 (2016). https://doi.org/10.1007/s10096-016-2601-4

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