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10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

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Community-acquired versus community-onset/healthcare-associated Staphylococcus aureus bacteremia – a single center study

Ambulant erworbene Staphylococcus aureus-Bakteriämie – eine monozentrische Auswertung

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  • S. Rieg - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany
  • G. Peyerl-Hoffmann - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany
  • K. de With - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany
  • C. Theilacker - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany
  • D. Wagner - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany
  • J. Hübner - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany
  • M. Dettenkofer - Universitätsklinikum Freiburg, Sektion Krankenhaushygiene, Freiburg i.Br., Germany
  • A. Kaasch - Uniklinik Köln, Instutut für Medizinische Mikrobiologie, Immunologie und Hygiene, Köln, Germany
  • C. Schneider - Universitätsklinikum Freiburg, Abteilung Medizinische Mikrobiologie, Freiburg i.Br., Germany
  • H. Seifert - Uniklinik Köln, Instutut für Medizinische Mikrobiologie, Immunologie und Hygiene, Köln, Germany
  • W.V. Kern - Universitätsklinikum Freiburg, Zentrum Infektiologie und Reisemedizin, Freiburg i.Br., Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP60

doi: 10.3205/10kit116, urn:nbn:de:0183-10kit1168

Published: June 2, 2010

© 2010 Rieg et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Background: Staphylococcus aureus bacteremia (SAB) is a severe disease carrying a high risk of complications such as metastatic disease with deep-seated foci of infection, endocarditis, severe sepsis or recurrences – in particular in community-onset cases. In a recent European survey (n=1,838) the case-fatality rate at day 14 was 16% (Grundmann et al. PloS Med 2010; 7:e1000215), whereas in a recent Australian-New Zealand survey (n=1,865) the case-fatality rate at day 30 was 21% (Turnidge et al. Med J Aust 2009; 191:368). We reassessed all-cause case-fatality rates among community-acquired, community onset/healthcare-associated and nosocomial adult SAB cases seen during an 8-years period at a German university hospital.

Methods: Cases with SAB onset 2002-2005 were retrospectively analysed, and cases seen 2006–2009 were prospectively followed (within the INSTINCT cohort). Community-onset healthcare-associated SAB was defined as SAB within 48 h of admission in an outpatient with i) close health care contact (iv therapy, wound care, hemodialysis) within 30 days prior to SAB onset or ii) hospitalisation for 2 or more days within 90 days or iii) continuous residency in a nursing home.

Results: Of 730 cases, 211 were community-acquired, 161 were community onset/healthcare-associated, and 358 (49%) were nosocomial. Community-acquired cases when compared with community onset/healthcare-associated cases showed fewer cases with MRSA (<1 vs 12%, OR 0.05 [0.006–0.35]), more endocarditis (29 vs 11%, OR 3.3 [1.9–5.7]), more metastatic disease (57 vs 35%, OR 2.5 [1.6–3.8]), and a higher proportion of iv drug abusers (14 vs 2%, OR 6.9 [2.5–18.5]). The case-fatality rates at day 14 and day 30 were similar in the two groups (table). The rates were higher than among nosocomial SAB cases.

(Table 1 [Tab. 1])

Conclusions: The case-fatality rate among community-onset SAB is higher than that among nosocomial cases and remains high at this center with a >10% rate at day 14. The data allow a better estimation of the burden of disease and – together with multicenter surveys such as preSABATO – provide useful estimates for the planning of further epidemiological and interventional studies.