Monday, May 29, 2023
Characteristics of Staphylococcus aureus Infections, Veterans Affairs Maryland Health Care System, Fiscal Years 1999–2008
Incidence and Type of Staphylococcus aureus Infections, Veterans Affairs Maryland Health Care System, Fiscal Years 1999–2008
This activity is intended for public health officials, infectious disease experts, hospital administrators, and other health professionals studying trends in S aureus infections for planning and prevention purposes.
The goal of this activity is to describe epidemiologic trends during a 10-year period regarding prevalence of overall and specific S aureus infections in a Maryland Veterans Administration hospital system.
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CME Released: 2/25/2011
Valid for credit through: 2/25/2012
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Trends in Staphylococcus aureus infections are not well described. To calculate incidence in overall S. aureus infection and invasive and noninvasive infections according to methicillin susceptibility and location, we conducted a 10-year population-based retrospective cohort study (1999–2008) using patient-level data in the Veterans Affairs Maryland Health Care System. We found 3,674 S. aureus infections: 2,816 (77%) were noninvasive; 2,256 (61%) were methicillin-resistant S. aureus (MRSA); 2,517 (69%) were community onset, and 1,157 (31%) were hospital onset. Sixty-one percent of noninvasive infections were skin and soft tissue infections; 1,112 (65%) of these were MRSA. Ten-year averaged incidence per 100,000 veterans was 749 (± 132 SD, range 549–954) overall, 178 (± 41 SD, range 114–259) invasive, and 571 (± 152 SD, range 364–801) noninvasive S. aureus infections. Incidence of all S. aureus infections significantly increased (p<0.001), driven by noninvasive, MRSA, and community-onset infections (p<0.001); incidence of invasive S. aureus infection significantly decreased (p<0.001).
Staphylococcus aureus exists as a commensal organism living on the human body in equilibrium with other bacteria and as a common agent associated with a spectrum of diseases ranging from mild, noninvasive skin and soft tissue infections (SSTIs) to invasive, life-threatening bloodstream infections. Increasing incidence of infections caused by methicillin-resistant S. aureus (MRSA) has complicated treatment of S. aureus infection. Previously MRSA infections were problematic primarily among hospitalized persons or persons exposed to the health care settings. However, since the 1990s, MRSA infections have become more prevalent in healthy, younger persons who have little to no exposure to health care settings. Of particular concern is the rapid increase in MRSA SSTIs reportedly driven by emergence of a new MRSA strain, USA300.[1,2]
Despite these changes, the epidemiology of S. aureus infection, particularly the total effect of infection in the United States, is not well described. Several population-based studies on S. aureus infections exist; however, these studies focused on hospital-based populations,[3–6] MRSA infection,[7–9] non-US populations,[10–12] or only estimated the impact of invasive S. aureus disease.[10,13–15] Additionally, population-level changes in incidence, particularly before and after USA300 MRSA emerged, are largely unknown. To describe overall trends and recent changes in the incidence of S. aureus infection while differentiating between invasive and noninvasive, community- and hospital-onset, and methicillin-susceptible and -resistant S. aureus infections, we conducted a retrospective population-based study.
