The changing epidemiology of Staphylococcus aureus bloodstream infection: a multinational population-based surveillance study

Abstract

Although the epidemiology of Staphylococcus aureus bloodstream infection (BSI) has been changing, international comparisons are lacking. We sought to determine the incidence of S. aureus BSI and assess trends over time and by region. Population-based surveillance was conducted nationally in Finland and regionally in Canberra, Australia, western Sweden, and three areas in each of Canada and Denmark during 2000-2008. Incidence rates were age-standardized and gender-standardized to the EU 27-country 2007 population. During 83 million person-years of surveillance, 18,430 episodes of S. aureus BSI were identified. The overall annual incidence rate for S. aureus BSI was 26.1 per 100,000 population, and those for methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) were 24.2 and 1.9 per 100,000, respectively. Although the overall incidence of community-onset MSSA BSI (15.0 per 100,000) was relatively similar across regions, the incidence rates of hospital-onset MSSA (9.2 per 100,000), community-onset MRSA (1.0 per 100,000) and hospital-onset MRSA (0.8 per 100,000) BSI varied substantially. Whereas the overall incidence of S. aureus BSI did not increase over the study period, there was an increase in the incidence of MRSA BSI. Major changes in the occurrence of community-onset and hospital-onset MSSA and MRSA BSI occurred, but these varied significantly among regions, even within the same country. Although major changes in the epidemiology of community-onset and hospital-onset MSSA and MRSA BSIs are occurring, this multinational population-based study did not find that the overall incidence of S. aureus BSI is increasing.

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

“…Overall, these data support the estimate that the contemporary incidence of community-onset Staphylococcus aureus BSI is approximately 15 per 100,000 in Western countries and is associated with a 30-day all-cause case fatality rate of 20% and a mortality rate of 3 per 100,000 (107). Notably, MRSA strains vary widely internationally, and in some cases MRSA appears to add to and in others replaces the burden due to methicillin-sensitive S. aureus (MSSA) (85).…”

“…Staphylococcus aureus is the second most common species causing BSI in population-based studies, and there is an evolving body of literature focusing specifically on this pathogen (2,6,8,9). Table 4 displays studies investigating the burden of community-onset Staphylococcus aureus BSI in nonselected populations (63,(82)(83)(84)(85)(86). Several other population-based studies, in addition to those presented in Table 3, have been reported but either had older or duplicative data with tabulated studies (87)(88)(89)(90), were limited to subgroups such as MRSA only (91)(92)(93)(94), included selected age groups (95-101), or did not report or clearly differentiate between community-and hospital-onset disease (102)(103)(104)(105)(106).…”

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

“…In the industrialized world, the population incidence of SAB ranges from 10 to 30 per 100,000 person-years (7). Longitudinal data from Denmark provide considerable insight into the impact of changes in access to health care interventions on SAB incidence.…”

Epidemiology of antimicrobial resistance in bloodstream infections

“…29 Community-acquired MRSA infections have emerged as a global problem since the turn of the 21 st century. [30][31][32] Five major clones are found to be associated with most of the CA-MRSA infections worldwide including multilocus sequence type 1 (ST-1)/USA400 and ST-8/USA300 dominantly found in North America, ST-59 observed in South East Asia, ST-80 observed in Europe and ST-30 distributed worldwide 28 . The clonal structure remains to be determined in CAESAR countries.…”