Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000

Abstract

Staphylococcus aureus is a leading cause of bacteraemia. This study analysed temporal trends from 18,702 adult cases of S. aureus bacteraemia in Denmark between 1981 and 2000. After stratification for mode of acquisition, 57% of cases were hospital-acquired (HA), 28% were community-acquired (CA) and 15% were of undetermined acquisition (UA). Incidence rates increased from 18.2 to 30.5 cases/100,000 population. Annual rates increased by 6.4% for CA, by 2.2% for HA and by 3.6% for UA cases, respectively. Case-mortality associated with HA bacteraemia decreased from 36.2% to 20.7% (43% rate reduction, p 0.0001), compared with a decrease from 34.5% to 26.5% (23% rate reduction, p 0.0001) for CA bacteraemia. Following multivariate analysis, age, pneumonia, endocarditis and chronic illness were associated with increased mortality, regardless of the mode of acquisition. Overall, mortality associated with S. aureus bacteraemia declined significantly between 1981 and 2000, but incidence rates doubled, so that the total number of deaths increased. These data emphasise the public health importance of S. aureus bacteraemia and the need for further preventive measures and improved care in order to reduce incidence rates and improve outcomes.

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study*

“…The prevalence of MRSA in Denmark is low [16] and, correspondingly, rates were low among HIV-infected individuals and comparable to those in the general population.…”

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…The infrequent vancomycin dosing strategy often used among hemodialysis-dependent patients may not maintain an adequate trough level in high-flux, large-poresize artificial kidneys (46)(47)(48), increasing the risk for relapsing SAB. Table 1 summarizes the incidences of SAB from the abovementioned studies and other studies (49)(50)(51)(52)(53)(54)(55).…”

Predictors of Mortality in Staphylococcus aureus Bacteremia

“…The exact incidence of SAB is difficult to ascertain, as prospective population-based surveillance studies are infrequently performed. In Scandinavian countries, where data from the nationwide surveillance of SAB are routinely collected, the annual incidence is approximately 26/100,000 population (14,119,128). A similar low incidence of 19.7/100,000 population was reported in a Canadian study in 2008 (160), while in countries with a greater burden of methicillin-resistant S. aureus (MRSA), incidence rates are generally higher, between 35 and 39/100,000 population (38,56,233).…”

“…Similarly, younger adults have lower incidence rates than older adults (14,160). Other factors associated with higher incidences include male gender, African American ethnicity, community-onset SAB, and specific patient subgroups that have frequent health care contact, including hemodialysis patients (160,201,229).…”