Abstract
The epidemiology of Staphylococcus aureus
bloodstream infections has changed in recent decades, with an
increase in the proportion due to methicillin-resistant S.
aureus (MRSA) occurring outside of a hospital setting. This
change is due in part to shifting of healthcare to the outpatient
setting and the emergence of community-onset MRSA as a cause of
skin and soft-tissue infections. Using all initial S. aureus
positive blood cultures at one hospital during the first four years
of 3 decades (1990-1993, 2000-2003, and 2010-2013), we hypothesized
that prior hospital admission within one month would be associated
with a greater risk for methicillin resistance among those with
S. aureus bloodstream infection. The number of S.
aureus bloodstream infections increased from 432 (1990-1993) to
637 (2000-2003), then decreased to 432 in the most recent study
period (2010-2013). The decrease in the number of infections
between the middle and last time periods was largely driven by a
50% decrease in infections occurring in the hospital. Similarly,
the percent MRSA increased from 25% (1990-1993) to 52% (2000-2003)
then declined to 47% in the most recent study period (2010-2013).
The proportion with community-onset infections, end-stage renal
disease, and HIV increased over time. Mortality was higher among
those patients with MRSA in all study periods. The final model
based on backward selection included patient age, whether the
infection occurred in a community setting, HIV diagnosis, and the
time period in which the culture was collected. Analysis showed no
significant association between prior admission in the last month
and methicillin resistance among these bloodstream infections
(P= 0.35). While we could not demonstrate that prior
hospitalization was a risk for developing MRSA bloodstream
infections, the drop in hospital-onset S. aureus bloodstream
infections in the last study period was striking. S. aureus
bloodstream infections are still a problem, but prevention efforts
may be decreasing the observed incidence. Future directions may
include expanding hospital-based efforts to the outpatient
setting.
Table of Contents
Introduction 1
Background 1
Methods 2
Results 6
Discussion 11
Table 1a 15
Table 1b 17
Table 2 19
Table 3 21
Table 4 23
Table 5 25
Table 6 27
Table 7 30
Table 8 31
Table 9 32
References 33
Appendix A: SAS Code 35
About this Master's Thesis
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