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Epidemiology of Staphylococcus aureus bacteremia in Denmark
F Espersen1, V T Rosdahl, N Frimodt-Młller
1Division of Preventive Microbiology, State Seruminstitute, Copenhagen, Denmark.
Abstract:
The number of Staphylococcus aureus bacteremia cases has increased annually in Denmark during the latest decades. This increase has occurred among older patients with hospital-acquired bacteremia. Methicillin-resistance, which earlier was a property of strains of the 83A phage-complex, has nearly disappeared, while the frequency of penicillin-resistance has increased. Today both the phage-type pattern and antibiotic resistance are nearly similar for strains from hospital-acquired and community-acquired cases. In hospitals the frequency of bacteremia after postoperative wound infections has decreased, while cases associated with intravascular catheters has increased, and these infections are now the most common cause of hospital-acquired S. aureus bacteremia. Endocarditis is most commonly found in community-acquired cases without an identified primary focus in patients between 21-50 years. Also hematogenous osteomyelitis is most common in community-acquired cases, but these infections have changed to having a high predilection for the vertebral column, and the prevalence of chronic cases has decreased.
Insights
Staphylococcus aureus bacteremia cases are rising in Denmark, particularly in older patients. Antibiotic resistance patterns are shifting, with increased penicillin resistance and decreased methicillin resistance in S. aureus strains.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Annual increase in Staphylococcus aureus bacteremia cases in Denmark over recent decades.
- Rise in hospital-acquired bacteremia predominantly affecting older patients.
Purpose of the Study:
- To analyze trends in Staphylococcus aureus bacteremia in Denmark.
- To investigate changes in antimicrobial resistance and phage-type patterns.
- To identify shifts in the sources and types of S. aureus bacteremia.
Main Methods:
- Retrospective analysis of S. aureus bacteremia cases in Denmark.
- Monitoring of antimicrobial resistance and phage-typing of S. aureus strains.
- Comparison of hospital-acquired versus community-acquired bacteremia characteristics.
Main Results:
- Increased incidence of S. aureus bacteremia, primarily hospital-acquired in older individuals.
- Near disappearance of methicillin resistance, concurrent with increased penicillin resistance.
- Similar phage-type and antibiotic resistance profiles for hospital- and community-acquired strains.
- Shift in hospital-acquired bacteremia sources from postoperative wounds to intravascular catheters.
- Endocarditis and vertebral osteomyelitis are common in community-acquired cases, with a decrease in chronic osteomyelitis.
Conclusions:
- S. aureus bacteremia epidemiology in Denmark has evolved, with significant changes in resistance patterns and sources of infection.
- Intravascular catheter-associated infections are now the leading cause of hospital-acquired S. aureus bacteremia.
- Community-acquired S. aureus infections show distinct patterns, particularly endocarditis and vertebral osteomyelitis.