Staphylococcus aureusInfections in US Veterans, Maryland, USA, 1999–20081

Abstract

Trends in Staphylococcus aureus infections are not well described. To calculate incidence in overall S. aureus infection and invasive and noninvasive infections according to methicillin susceptibility and location, we conducted a 10-year population-based retrospective cohort study (1999–2008) using patient-level data in the Veterans Affairs Maryland Health Care System. We found 3,674 S. aureus infections: 2,816 (77%) were noninvasive; 2,256 (61%) were methicillin-resistant S. aureus (MRSA); 2,517 (69%) were community onset, and 1,157 (31%) were hospital onset. Sixty-one percent of noninvasive infections were skin and soft tissue infections; 1,112 (65%) of these were MRSA. Ten-year averaged incidence per 100,000 veterans was 749 (± 132 SD, range 549–954) overall, 178 (± 41 SD, range 114–259) invasive, and 571 (± 152 SD, range 364–801) noninvasive S. aureus infections. Incidence of all S. aureus infections significantly increased (p<0.001), driven by noninvasive, MRSA, and community-onset infections (p<0.001); incidence of invasive S. aureus infection significantly decreased (p<0.001).

Characterization of Methicillin-Resistant Staphylococcus aureus Strains Recovered from a Phase IV Clinical Trial for Linezolid versus Vancomycin for Treatment of Nosocomial Pneumonia

“…Recently, this clone has also been implicated as a cause of health care-associated (HA-MRSA) and invasive infections (22,39,45). However, recent studies have demonstrated an overall increase of noninvasive, community-onset, MRSA infections, while the incidence of HA-MRSA and invasive infections declined (8,21,31,51). Similar changes in the MRSA epidemiology among European hospitals have been reported in numerous studies as well (6,9,14,16).…”

“…This species ranks as the main pathogen responsible for nosocomial bloodstream infections (BSI), hospital-acquired bacterial pneumonia (HABP) and ventilator-acquired bacterial pneumonia (VABP), and skin and skin structure infections (SSSI) (20,25). Many infections are caused by methicillin-resistant S. aureus (MRSA) isolates, and recent studies have demonstrated an increased MRSA incidence over the last decade (31,34,43,51). These facts, along with complicating risk factors, comorbidity, and mortality (between 40 and 60%), result in extended hospitalizations, escalated health care costs, and the requirement of potent, broad-spectrum agents often used in combination regimens (7).…”

Characterization of Alpha-Toxin hla Gene Variants, Alpha-Toxin Expression Levels, and Levels of Antibody to Alpha-Toxin in Hemodialysis and Postsurgical Patients with Staphylococcus aureus Bacteremia

“…The risk of invasive S. aureus infections is significantly higher among certain subgroups, including hemodialysisdependent patients and postoperative patients (12)(13)(14).These high-risk subpopulations are potential candidates for novel forms of prevention or treatment against invasive S. aureus infections.…”

Impact of Strain Typing Methods on Assessment of Relationship between Paired Nares and Wound Isolates of Methicillin-Resistant Staphylococcus aureus

“…Skin and soft tissue infections (SSTI) were the most commonly reported type of infection (1), and 65% of SSTI were caused by MRSA, as reported by one VA hospital (2). As a result, in 2007, the VA system instituted a nationwide acute-care surveillance program in their 153 medical centers with the aim of decreasing both carriage and disease due to MRSA (3).…”