Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand.
OBJECTIVE
To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality.


METHODS
Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web-based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008.


METHODS
30-day all-cause mortality.


RESULTS
1994 episodes of S. aureus bacteraemia were identified, and complete 30-day follow-up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%-63.0%). Methicillin-resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%-25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community-associated MRSA. All-cause mortality at 30 days was 20.6% (95% CI, 18.8%-22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non-beta-lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device-associated infection with a secondary focus, left-sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection.


CONCLUSIONS
S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life-threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web-based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.
Turnidge
John D
JD
Women's and Children's Hospital, Adelaide, SA, Australia. john.turnidge@health.sa.gov.au
Kotsanas
Despina
D
Munckhof
Wendy
W
Roberts
Sally
S
Bennett
Catherine M
CM
Nimmo
Graeme R
GR
Coombs
Geoffrey W
GW
Murray
Ronan J
RJ
Howden
Benjamin
B
Johnson
Paul D R
PD
Dowling
Kate
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D013211:Staphylococcus aureus; D055815:Young Adult