Staphylococcus aureus bacteraemia (SAB) is a leading cause of infection related morbidity and mortality within healthcare systems. A rising incidence of SAB has been seen in institutions with advances in medical interventions. Infectious Diseases consultation has proven to result in improved outcomes in affected patients. There are sparse data regarding incidence and outcomes of SAB in the Caribbean healthcare system.
A retrospective sample of adult patients, admitted to a teaching hospital in Nassau, Bahamas with SAB between 1 January, 2012 and 31 December, 2015, was identified using patient medical records and microbiology database. Only patients ≥18 years with a first episode of SAB were included. Corresponding dockets were reviewed and data analysed using Microsoft Excel and the 2015 version of the Statistical Package for the Social Sciences.
Of all patients ≥18 years of age with positive blood cultures, a first episode of SAB was seen in 10.3% (201) of cases. Males represented 62.69% of cases with the 40-59 age group being most affected (42.52%). Most patients had Diabetes mellitus (37.31%) and End stage renal disease on dialysis (31.34%). No obvious source of infection was identified in 43.78%. Regarding source of acquisition, 12.44% were Nosocomial, 67.66% Healthcare-associated and 19.9% Community acquired.
For the study period, there was a significant 4.4% increase in occurrence (range of 8.66% to 11.54%) of SAB. MSSA represented 73.68% of cases with incidence ranging from 55.67/1000 (2013) to 95.89/1000 (2014) while MRSA bacteremia had an incidence ranging from 17.96/1000 (2012) to 35.37/1000 (2015).
30-day SAB mortality for the study period was 29.35% (range of 22.22% to 32.20%). The odds of death within 30 days from MRSA compared to MSSA was 1.90 (p=0.056). The 30 -day risk of death from community acquisition was 3.25 (p=0.001) compared to healthcare and 2.57 (p=0.08) compared to nosocomial.
SAB remains an important bacterial infection with alarmingly high 30 day mortality rates being demonstrated in this study. Strategies such as Infectious Disease consultation, improved antimicrobial stewardship and timely interventions are warranted to improve outcomes in these patients.
C. C. Bonimy,
D. Bannister, None
M. A. C. Frankson, None