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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; 41(3):210-3AJ

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.org

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., ... 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), pp. 210-3. doi: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 -