Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand

Abstract

Objective: To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality. Design and setting: Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web‐based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008. Main outcome measure: 30‐day all‐cause mortality. Results: 1994 episodes of S. aureus bacteraemia were identified, and complete 30‐day follow‐up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%–63.0%). Methicillin‐resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%–25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community‐associated MRSA. All‐cause mortality at 30 days was 20.6% (95% CI, 18.8%–22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non‐β‐lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device‐associated infection with a secondary focus, left‐sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection. Conclusions: S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life‐threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web‐based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.

Staphylococcus aureus bloodstream infection: A pooled analysis of five prospective, observational studies

“…Whether this is due to the delayed receipt of appropriate antimicrobials, less effective antimicrobials, confounding risk factors linked with the acquisition of MRSA, poorer quality of medical care for patients in contact-isolation, or study design, has been debated extensively. 16,23–25 These observations are not explained by differences in the proportions of patients with diabetes mellitus, although diabetes mellitus was significantly more common in patients with MRSA infection, which is in contrast to previously published findings. 26 …”

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…vancomycin vs. semi-synthetic penicillin for invasive methicillin sensitive Staphylococcus aureus infections) 11, 12 , adverse events (e.g. ceftriaxone or clindamycin and Clostridium difficile ) 13, 14 and microbiological resistance.…”

Incidence, trends and demographics of Staphylococcus aureus infections in Auckland, New Zealand, 2001–2011

“…adults only) or a specific place of acquisition (e.g. healthcare-associated infections) [6-8]. Furthermore, as a consequence of the recent epidemic of community-associated methicillin resistant S. aureus (CA-MRSA) in North America, many studies have focused exclusively on describing the epidemiology and burden of MRSA infections [9,10].…”