The epidemiology of Staphylococcus aureus bacteraemia in Tasmania
Brett G. Mitchell A B E , Anne Gardner A C and Lee Stewart DA Australian Catholic University, School of Nursing Midwifery and Paramedicine, PO Box 256, Dickson, ACT 2602, Australia.
B University of Tasmania, School of Nursing and Midwifery, Private Bag 135, Hobart, Tas. 7000, Australia.
C National Centre for Clinical Outcomes Research (NaCCOR), PO Box 968, North Sydney, NSW 2059, Australia.
D James Cook University, Nursing Midwifery and Nutrition, Townsville, Qld 4811, Australia.
E Corresponding author. Email: bgmitc001@myacu.edu.au
Healthcare Infection 17(3) 98-103 https://doi.org/10.1071/HI12020
Submitted: 11 June 2012 Accepted: 31 July 2012 Published: 22 August 2012
Abstract
Background: The seriousness of Staphylococcus aureus bacteraemia (SAB), coupled with the potential to reduce its occurrence, suggests that each case of SAB demands rigorous investigation and epidemiological understanding. To accurately determine the incidence and better understand the epidemiology of SAB at a population level, detailed data about SAB need to be collected from all settings, not just publicly funded hospitals. The aim of this study was to understand the epidemiology of SAB in Tasmania and to quantify the extent to which SAB incidence is under reported if only public hospital data are reported.
Methods: A population-based observational study for all people who had laboratory-identified SAB during 2009 and 2010 in Tasmania was conducted. The incidence of SAB was calculated using population data.
Results: Incidence of SAB was calculated as 21.3 per 100 000 population per year (95% CI 18.51–24.31). The majority of SAB cases were community associated (58.4%) and were caused by methicillin-sensitive Staphylococcus aureus (90.7%). Fifty-five percent of healthcare-associated SAB cases were associated with an intravascular device. Eleven percent of all SAB cases were identified in a private hospital.
Conclusion: This study represents the first known Australian study to capture and analyse data from all cases of SAB in a well-defined population, enabling calculation of incidence. The incidence of SAB in Tasmania is lower than in other Australian studies. Community-associated SAB is more common than healthcare-associated SAB yet little attention is paid to this community burden nationally. Current national surveillance programs for SAB focus only on public hospitals and, in doing so, a significant number of cases of SAB are missed.
References
[1] Whitby M, McLaws ML, Berry G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001; 175 264–7.[2] Collignon P, Dreimanis D, Beckingham W, Roberts J, Gardner A. Intravascular catheter bloodstream infections: an effective and sustained hospital-wide prevention program over 8 years. Med J Aust 2007; 187 551–4.
[3] Grayson ML, Jarvie LJ, Martin R, Johnson PDR, Jodoin ME, McMullan C, et al Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008; 188 633–40.
[4] Australian Bureau of Statistics. 1307.6 – Tasmanian State and Regional Indicators, Jun 2010. Belconnen, ACT: ABS; 2011. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1307.6Jun%202010?OpenDocument [verified 29 April 2011].
[5] Australian Commission on Safety and Quality in Healthcare. Data Dictionary and Collection Guidelines for the Surveillance of Healthcare Associated Infections: Staphylococcus aureus bacteraemia & Clostridium difficile Infection. Darlinghurst, NSW: Australian Commission on Safety and Quality in Healthcare; 2009.
[6] Mitchell B, Gardner A, Collignon P, Stewart L, Cruickshank M. A literature review supporting the proposed national Australian definition for ‘Staphylococcus aureus’ bacteraemia. Healthc Infect 2010; 15 105–11.
| A literature review supporting the proposed national Australian definition for ‘Staphylococcus aureus’ bacteraemia.Crossref | GoogleScholarGoogle Scholar |
[7] Australian Commission on Safety and Quality in Healthcare. Data Dictionary and Collection Guidelines for the Surveillance of Healthcare Associated Infections: Staphylococcus aureus bacteraemia & Clostridium difficile Infection. Darlinghurst, NSW: Australian Commission on Safety and Quality in Health Care; 2010.
[8] Mitchell B, McGregor A, Brown S, Wells A. Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report, Report No. 8. Hobart: TIPCU, Department of Health and Human Services; 2011.
[9] Huggan PJ, Wells JE, Browne M, Richardson A, Murdoch DR, Chambers ST. Population-based epidemiology of Staphylococcus aureus bloodstream infection in Canterbury, New Zealand. Intern Med J 2010; 40 117–25.
| Population-based epidemiology of Staphylococcus aureus bloodstream infection in Canterbury, New Zealand.Crossref | GoogleScholarGoogle Scholar |
[10] Lamagni TL, Potz N, Powell D, Pebody R, Wilson J, Duckworth G. Mortality in patients with meticillin-resistant Staphylococcus aureus bacteraemia, England 2004–2005. J Hosp Infect 2011; 77 16–20.
| Mortality in patients with meticillin-resistant Staphylococcus aureus bacteraemia, England 2004–2005.Crossref | GoogleScholarGoogle Scholar |
[11] Lessa FC, Mu Y, Davies J, Murray M, Lillie M, Pearson A, et al Comparison of Incidence of bloodstream infection with methicillin-resistant Staphylococcus aureus between England and United States, 2006–2007. Clin Infect Dis 2010; 51 925–8.
[12] Asgeirsson H, Gudlaugsson O, Kristinsson KG, Heiddal S, Kristjansson M. Staphylococcus aureus bacteraemia in Iceland, 1995–2008: changing incidence and mortality. Clin Microbiol Infect 2011; 17 513–8.
| Staphylococcus aureus bacteraemia in Iceland, 1995–2008: changing incidence and mortality.Crossref | GoogleScholarGoogle Scholar |
[13] Turnidge J, Nimmo G, Pearson J, Gottlieb T, Collignon P, Australian Group on Antimicrobial Resistance. Epidemiology and outcomes for Staphylococcus aureus bacteraemia in Australian hospitals, 2005–06: report from the Australian Group on Antimicrobial Resistance. Commun Dis Intell 2007; 31 398–403.
[14] Collignon P, Nimmo G, Gottlieb T, Gosbell I, Australian Group on Antimicrobial Resistance. Staphylococcus aureus bacteremia, Australia. Emerg Infect Dis 2005; 11 554–61.
| Staphylococcus aureus bacteremia, Australia.Crossref | GoogleScholarGoogle Scholar |
[15] Collignon P, Cruickshank M, Dreimanis D. Staphylococcus aureus bloodstream infections: an important indicator for infection control. Chapter 2: Bloodstream infections – an abridged version. Healthc Infect 2009; 14 165–71.
| Staphylococcus aureus bloodstream infections: an important indicator for infection control. Chapter 2: Bloodstream infections – an abridged version.Crossref | GoogleScholarGoogle Scholar |
[16] Collignon PJ, Wilkinson IJ, Gilbert GL, Grayson ML, Whitby RM. Health care-associated Staphylococcus aureus bloodstream infections: a clinical quality indicator for all hospitals. Med J Aust 2006; 184 404–6.
[17] Easton M, Veitch M. Ten years of Staphylococcus aureus bloodstream and cerebrospinal fluid isolates in Victoria: reports to the Victorian Hospital Pathogen Surveillance Scheme, 1999–2008. Vic Infect Dis Bull 2010; 13 2–6.
[18] Health Protection Agency. Health Protection Report. London: Health Protection Agency; 2011.
[19] Health Protection Agency. Voluntary reporting of Staphylococcus aureus bacteraemia in England, Wales and Northern Ireland, 2010. London: Health Protection Agency; 2011.
[20] Morin CA, Hadler JL. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan connecticut areas, 1998. J Infect Dis 2001; 184 1029–34.
[21] Laupland KB, Ross T, Gregson DB. Staphylococcus aureus bloodstream infections: risk factors, outcomes, and the influence of methicillin resistance in Calgary, Canada, 2000–2006. J Infect Dis 2008; 198 336–43.
| Staphylococcus aureus bloodstream infections: risk factors, outcomes, and the influence of methicillin resistance in Calgary, Canada, 2000–2006.Crossref | GoogleScholarGoogle Scholar |
[22] Collignon PJ, Wilkinson IJ, Gilbert GL, Grayson ML, Whitby RM. Health care-associated Staphylococcus aureus bloodstream infections: a clinical quality indicator for all hospitals. Med J Aust 2006; 184 404–6.
[23] Australian Institute of Health and Welfare. MyHospitals. Canberra: Australian Institute of Health and Welfare; 2011. Available from: http://www.myhospitals.gov.au/ [verified 18 November 2011].
[24] Van Gessel H, McCann R, Peterson A, Cope C, Wilkinson I, Mitchell B., et al. Implementation guide for surveillance of Staphylococcus aureus bacteraemia. Darlinghurst, NSW: Australian Commission on Safety and Quality in Health Care; 2011.
[25] Mitchell B, McGregor A, Coombs G. Prevalence of methicillin-resistant Staphylococcus aureus colonisation in Tasmanian rural hospitals. Healthc Infect 2009; 14 159–63.
| Prevalence of methicillin-resistant Staphylococcus aureus colonisation in Tasmanian rural hospitals.Crossref | GoogleScholarGoogle Scholar |