Stable incidence and continued improvement in short term mortality of Staphylococcus aureus bacteraemia between 1995 and 2008

Niels Mejer, Henrik Westh, Henrik C Schønheyder, Allan G Jensen, Anders R Larsen, Robert Skov, Thomas Benfield, Danish Staphylococcal Bacteraemia Study Group, Niels Mejer, Henrik Westh, Henrik C Schønheyder, Allan G Jensen, Anders R Larsen, Robert Skov, Thomas Benfield, Danish Staphylococcal Bacteraemia Study Group

Abstract

Background: The objective of this study was to assess temporal changes in incidence and short term mortality of Staphylococcus aureus bacteraemia (SAB) from 1995 through 2008.

Methods: The study was conducted as a nation-wide observational cohort study with matched population controls. The setting was hospitalized patients in Denmark 1995-2008. Uni- and multivariate analyses were used to analyze the hazard of death within 30 days from SAB.

Results: A total of 16 330 cases of SAB were identified: 57% were hospital-associated (HA), 31% were community-acquired (CA) and 13% were of undetermined acquisition. The overall adjusted incidence rate remained stable at 23 per 100 000 population but the proportion of SAB cases older than 75 years increased significantly. Comorbidity in the cohort as measured by Charlson comorbidity index (CCI) score and alcohol-related diagnoses increased over the study period. In contrast, among the population controls the CCI remained stable and alcohol-related diagnoses increased slightly. For HA SAB crude 30-day mortality decreased from 27.8% to 21.8% (22% reduction) whereas the change for CA SAB was small (26.5% to 25.8%). By multivariate Cox regression, age, female sex, time period, CCI score and alcohol-related diagnoses were associated with increased mortality regardless of mode of acquisition.

Conclusions: Throughout a 14-year period the overall incidence of SAB remained stable while the overall short term prognosis continued to improve despite increased age and accumulation of comorbidity in the cohort. However, age and comorbidity were strong prognostic indicators for short term mortality.

Figures

Figure 1
Figure 1
Survival curves of 16630 cases with Staphylococcus aureus bacteraemia between 1995 and 2008 according to age.
Figure 2
Figure 2
Survival curves of 16630 cases with Staphylococcus aureus bacteraemia between 1995 and 2008 according to Charlson comorbidity index score.

References

    1. Dini E, Goldring S. Estimating the changing population of the ‘oldest old’. Popul Trends. 2008;132:8–16.
    1. Anonymous. Population figures. Danmarks Statistik 2011Available from. URL: .
    1. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21. doi: 10.1097/.
    1. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–2276. doi: 10.1001/archinte.162.20.2269.
    1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–1554. doi: 10.1056/NEJMoa022139.
    1. 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(3):257–263. doi: 10.1111/j.1469-0691.2006.01589.x.
    1. Sogaard M, Norgaard M, Dethlefsen C, Schonheyder HC. Temporal changes in the incidence and 30-day mortality associated with bacteremia in hospitalized patients from 1992 through 2006: a population-based cohort study. Clin Infect Dis. 2011;52(1):61–69. doi: 10.1093/cid/ciq069.
    1. Pedersen CB, Gotzsche H, Moller JO, Mortensen PB. The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull. 2006;53(4):441–449.
    1. Jessen O, Rosendal K, Bülow P, Faber V, Eriksen KR. Changing staphylococci and staphylococcal infections. A ten-year study of bacteria and cases of bacteremia. N Engl J Med. 1969;281:627–635. doi: 10.1056/NEJM196909182811201.
    1. Skov RL, Pallesen LV, Poulsen RL, Espersen F. Evaluation of a new 3-h hybridization method for detecting the mecA gene in Staphylococcus aureus and comparison with existing genotypic and phenotypic susceptibility testing methods. J Antimicrob Chemother. 1999;43(4):467–475. doi: 10.1093/jac/43.4.467.
    1. Larsen AR, Stegger M, Bocher S, Sorum M, Monnet DL, Skov RL. Emergence and characterization of community-associated methicillin-resistant Staphyloccocus aureus infections in Denmark, 1999 to 2006. J Clin Microbiol. 2009;47(1):73–78. doi: 10.1128/JCM.01557-08.
    1. Wacholder S, Silverman DT, McLaughlin JK, Mandel JS. Selection of controls in case–control studies. II. Types of controls. Am J Epidemiol. 1992;135(9):1029–1041.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288–1294. doi: 10.1016/j.jclinepi.2004.03.012.
    1. De Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity. a critical review of available methods. J Clin Epidemiol. 2003;56(3):221–229. doi: 10.1016/S0895-4356(02)00585-1.
    1. Linderoth G, Jepsen P, Schonheyder HC, Johnsen SP, Sorensen HT. Short-term prognosis of community-acquired bacteremia in patients with liver cirrhosis or alcoholism: A population-based cohort study. Alcohol Clin Exp Res. 2006;30(4):636–641. doi: 10.1111/j.1530-0277.2006.00074.x.
    1. Harboe ZB, Thomsen RW, Riis A, Valentiner-Branth P, Christensen JJ, Lambertsen L. et al.Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study. PLoS Med. 2009;6(5):e1000081. doi: 10.1371/journal.pmed.1000081.
    1. 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(3):336–343. doi: 10.1086/589717.
    1. 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(9):1452–1459. doi: 10.1086/374621.
    1. Wisplinghoff H, Seifert H, Tallent SM, Bischoff T, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J. 2003;22(8):686–691. doi: 10.1097/01.inf.0000078159.53132.40.
    1. Lyytikainen O, Ruotsalainen E, Jarvinen A, Valtonen V, Ruutu P. Trends and outcome of nosocomial and community-acquired bloodstream infections due to Staphylococcus aureus in Finland, 1995–2001. Eur J Clin Microbiol Infect Dis. 2005;24(6):399–404. doi: 10.1007/s10096-005-1345-3.

Source: PubMed

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