<i>Staphylococcus aureus</i> bloodstream infections: diverging trends of meticillin-resistant and meticillin-susceptible isolates, EU/EEA, 2005 to 2018

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Abstract

Background

Invasive infections caused by Staphylococcus aureus have high clinical and epidemiological relevance. It is therefore important to monitor the S. aureus trends using suitable methods.

Aim

The study aimed to describe the trends of bloodstream infections (BSI) caused by meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA) in the European Union (EU) and the European Economic Area (EEA).

Methods

Annual data on S. aureus BSI from 2005 to 2018 were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net). Trends of BSI were assessed at the EU/EEA level by adjusting for blood culture set rate (number of blood culture sets per 1,000 days of hospitalisation) and stratification by patient characteristics.

Results

Considering a fixed cohort of laboratories consistently reporting data over the entire study period, MRSA percentages among S. aureus BSI decreased from 30.2% in 2005 to 16.3% in 2018. Concurrently, the total number of BSI caused by S. aureus increased by 57%, MSSA BSI increased by 84% and MRSA BSI decreased by 31%. All these trends were statistically significant (p < 0.001).

Conclusions

The results indicate an increasing health burden of MSSA BSI in the EU/EEA despite a significant decrease in the MRSA percentage. These findings highlight the importance of monitoring antimicrobial resistance trends by assessing not only resistance percentages but also the incidence of infections. Further research is needed on the factors associated with the observed trends and on their attributable risk.

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Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Alessandro Cassini, Liselotte Diaz Högberg, Diamantis Plachouras … (2019)

Summary Background Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases. Funding European Centre for Disease Prevention and Control.

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Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research

Nicholas A Turner, Batu Sharma-Kuinkel, Stacey A Maskarinec … (2019)

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most successful modern pathogens. The same organism that lives as a commensal and is transmitted in both health-care and community settings is also a leading cause of bacteraemia, endocarditis, skin and soft tissue infections, bone and joint infections and hospital-acquired infections. Genetically diverse, the epidemiology of MRSA is primarily characterized by the serial emergence of epidemic strains. Although its incidence has recently declined in some regions, MRSA still poses a formidable clinical threat, with persistently high morbidity and mortality. Successful treatment remains challenging and requires the evaluation of both novel antimicrobials and adjunctive aspects of care, such as infectious disease consultation, echocardiography and source control. In this Review, we provide an overview of basic and clinical MRSA research and summarize the expansive body of literature on the epidemiology, transmission, genetic diversity, evolution, surveillance and treatment of MRSA.

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Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections — United States

Athena Kourtis, Kelly Hatfield, James Baggs … (2019)

Introduction Staphylococcus aureus is one of the most common pathogens in health care facilities and in the community, and can cause invasive infections, sepsis, and death. Despite progress in preventing methicillin-resistant S. aureus (MRSA) infections in health care settings, assessment of the problem in both health care and community settings is needed. Further, the epidemiology of methicillin-susceptible S. aureus (MSSA) infections is not well described at the national level. Methods Data from the Emerging Infections Program (EIP) MRSA population surveillance (2005–2016) and from the Premier and Cerner Electronic Health Record databases (2012–2017) were analyzed to describe trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and to estimate the overall incidence of S. aureus bloodstream infections in the United States and associated in-hospital mortality. Results In 2017, an estimated 119,247 S. aureus bloodstream infections with 19,832 associated deaths occurred. During 2005–2012 rates of hospital-onset MRSA bloodstream infection decreased by 17.1% annually, but the decline slowed during 2013–2016. Community-onset MRSA declined less markedly (6.9% annually during 2005–2016), mostly related to declines in health care–associated infections. Hospital-onset MSSA has not significantly changed (p = 0.11), and community-onset MSSA infections have slightly increased (3.9% per year, p<0.0001) from 2012 to 2017. Conclusions and Implications for Public Health Practice Despite reductions in incidence of MRSA bloodstream infections since 2005, S. aureus infections account for significant morbidity and mortality in the United States. To reduce the incidence of these infections further, health care facilities should take steps to fully implement CDC recommendations for prevention of device- and procedure-associated infections and for interruption of transmission. New and novel prevention strategies are also needed.

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Author and article information

Journal

Journal ID (nlm-ta): Euro Surveill

Journal ID (iso-abbrev): Euro Surveill

Journal ID (publisher-id): eurosurveillance

Title: Eurosurveillance

Publisher: European Centre for Disease Prevention and Control (ECDC)

ISSN (Print): 1025-496X

ISSN (Electronic): 1560-7917

Publication date (Print): 18 November 2021

Volume: 26

Issue: 46

Electronic Location Identifier: 2002094

Affiliations

[1 ]Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy

[2 ]European Centre for Disease Prevention and Control, Solna, Sweden

[3 ]Public Health Agency of Sweden, Solna, Sweden

[4 ]Healthcare-associated infections, surveillance of antimicrobial resistance and consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

[5 ]Division of Clinical Microbiology, Department of Laboratory medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

[6 ]Sorbonne Universités (Paris 06) Inserm Centre d'Immunologie et des Maladies Infectieuses (CIMI), UMR 1135 & APHP, Pitié-Salpêtrière hospital, Laboratoire de Bactériologie-Hygiène, Paris, France

[7 ]Clinical microbiology, Växjö Central hospital, Växjö, Sweden

[8 ]World Health Organization, Regional Office for Europe, Copenhagen, Denmark

[9 ]National Institute for Public Health and the Environment, Bilthoven, The Netherlands

[10 ]Health Protection Surveillance Centre, Dublin, Ireland

[11 ]Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway

[12 ]Research Group for Host Microbe Interaction, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway

[13 ]Norwegian Institute of Public Health, Oslo, Norway

[14 ]National Institute of Public Health, University of Ljubljana, Slovenia

[15 ]Zagreb University Hospital for Infectious Diseases, Zagreb, Croatia

[16 ]Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland

[17 ]National reference laboratory for antibiotics, National Institute of Public Health, Prague, Czech Republic

[18 ]Department of Microbiology, 3rd Faculty of Medicine Charles University, University hospital Kralovske Vinohrady, and National Institute of Public Health, Prague, Czech Republic

[19 ]EARS-Net study group participants are listed under Investigators

Author notes

Correspondence: Liselotte Diaz Högberg ( liselotte.diaz-hogberg@ 123456ecdc.europa.eu )

Article

Publisher ID: 2002094 Publisher ID: 2002094

DOI: 10.2807/1560-7917.ES.2021.26.46.2002094

PMC ID: 8603406

PubMed ID: 34794536

SO-VID: 78eb55c4-0d54-4fdf-a8ff-43321e6743e6

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.

History

Date received : 15 December 2020

Date accepted : 16 September 2021

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Keywords: staphylococcus aureus,mrsa,europe,antimicrobial resistance,bacterial infections,bloodstream infection

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Keywords: staphylococcus aureus, mrsa, europe, antimicrobial resistance, bacterial infections, bloodstream infection

Staphylococcus aureus bloodstream infections: diverging trends of meticillin-resistant and meticillin-susceptible isolates, EU/EEA, 2005 to 2018

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Abstract

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Point-Of-Care Testing for AMR

Most cited references 20

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research

Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections — United States

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