Dafna Yahav1,2, Hila Shaked3, Elad Goldberg4,5, Sharief Yassin6, Noa Eliakim-Raz7,8, Mical Paul4,9, Jihad Bishara3,4, Leonard Leibovici4,10. 1. Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. dafna.yahav@gmail.com. 2. Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel. dafna.yahav@gmail.com. 3. Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. 4. Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel. 5. Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel. 6. Department of Medicine D, The Chaim Sheba Medical Center, Tel Hashomer, Israel. 7. Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. noaeliakim@gmail.com. 8. Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel. noaeliakim@gmail.com. 9. Unit of Infectious Diseases, Rambam Hospital, Haifa, Israel. 10. Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Abstract
INTRODUCTION: Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. METHODS: We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients). RESULTS: In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010. CONCLUSIONS: In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.
INTRODUCTION: Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. METHODS: We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients). RESULTS: In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010. CONCLUSIONS: In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.
Authors: M Paul; N Zemer-Wassercug; O Talker; Y Lishtzinsky; B Lev; Z Samra; L Leibovici; J Bishara Journal: Clin Microbiol Infect Date: 2010-12-14 Impact factor: 8.067
Authors: Steven Y C Tong; Joshua S Davis; Emily Eichenberger; Thomas L Holland; Vance G Fowler Journal: Clin Microbiol Rev Date: 2015-07 Impact factor: 26.132
Authors: C Allard; A Carignan; M Bergevin; I Boulais; V Tremblay; P Robichaud; R Duperval; J Pepin Journal: Clin Microbiol Infect Date: 2008-03-04 Impact factor: 8.067