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Decreasing incidence of Staphylococcus aureus bacteremia over 9 years: greatest decline in community-associated methicillin-susceptible and hospital-acquired methicillin-resistant isolates.
Am J Infect Control. 2013 Mar; 41(3):210-3.AJ

Abstract

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 6.64/10(3) discharges in 2002-2003 to 6.49/10(3) in 2005-2006, 5.24/10(3) in 2008-2009, and 5.00/10(3) in 2010; P = .0001), with a greater decline in community-associated cases (0.99/10(3), 0.77/10(3), 0.58/10(3), and 0.40/10(3), respectively; P = .0005) compared with health care-associated cases (5.65/10(3), 5.72/10(3), 4.66/10(3), and 4.60/10(3), respectively; P = .005). The decline was principally in MSSA (3.11/10(3), 2.21/10(3), 2.24/10(3), and 1.75/10(3), 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.

Authors+Show Affiliations

Department of Medicine, St John Hospital and Medical Center, Grosse Pointe Woods, MI 48236, USA. riad.khatib@stjohn.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23040608

Citation

Khatib, Riad, et al. "Decreasing Incidence of Staphylococcus Aureus Bacteremia Over 9 Years: Greatest Decline in Community-associated Methicillin-susceptible and Hospital-acquired Methicillin-resistant Isolates." American Journal of Infection Control, vol. 41, no. 3, 2013, pp. 210-3.
Khatib R, Sharma M, Iyer S, et al. Decreasing incidence of Staphylococcus aureus bacteremia over 9 years: greatest decline in community-associated methicillin-susceptible and hospital-acquired methicillin-resistant isolates. Am J Infect Control. 2013;41(3):210-3.
Khatib, R., Sharma, M., Iyer, S., Fakih, M. G., Obeid, K. M., Venugopal, A., Fishbain, J., Johnson, L. B., Segireddy, M., Jose, J., & Riederer, K. (2013). Decreasing incidence of Staphylococcus aureus bacteremia over 9 years: greatest decline in community-associated methicillin-susceptible and hospital-acquired methicillin-resistant isolates. American Journal of Infection Control, 41(3), 210-3. https://doi.org/10.1016/j.ajic.2012.03.038
Khatib R, et al. Decreasing Incidence of Staphylococcus Aureus Bacteremia Over 9 Years: Greatest Decline in Community-associated Methicillin-susceptible and Hospital-acquired Methicillin-resistant Isolates. Am J Infect Control. 2013;41(3):210-3. PubMed PMID: 23040608.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decreasing incidence of Staphylococcus aureus bacteremia over 9 years: 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, Y1 - 2012/10/04/ PY - 2012/01/18/received PY - 2012/03/28/revised PY - 2012/03/28/accepted PY - 2012/10/9/entrez PY - 2012/10/9/pubmed PY - 2013/8/13/medline SP - 210 EP - 3 JF - American journal of infection control JO - Am J Infect Control VL - 41 IS - 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 6.64/10(3) discharges in 2002-2003 to 6.49/10(3) in 2005-2006, 5.24/10(3) in 2008-2009, and 5.00/10(3) in 2010; P = .0001), with a greater decline in community-associated cases (0.99/10(3), 0.77/10(3), 0.58/10(3), and 0.40/10(3), respectively; P = .0005) compared with health care-associated cases (5.65/10(3), 5.72/10(3), 4.66/10(3), and 4.60/10(3), respectively; P = .005). The decline was principally in MSSA (3.11/10(3), 2.21/10(3), 2.24/10(3), and 1.75/10(3), 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. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/23040608/Decreasing_incidence_of_Staphylococcus_aureus_bacteremia_over_9_years:_greatest_decline_in_community_associated_methicillin_susceptible_and_hospital_acquired_methicillin_resistant_isolates_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(12)00803-6 DB - PRIME DP - Unbound Medicine ER -