title: Healthcare-associated vs. hospital-acquired Staphylococcus aureus bacteremia.
abstract: OBJECTIVE
  To analyze clinical features and outcomes of patients with hospital-acquired (HA) and healthcare-associated (HCA) Staphylococcus aureus bacteremia.
  
  
  METHODS
  A retrospective cohort study was conducted from 1988 to 2007. We compared patients with clinically significant HA with those with HCA S. aureus bacteremia. Risk factors for 30-day all-cause mortality were assessed using multivariable logistic regression analysis. Cox regression analysis was used to estimate the hazard ratio (HR) for 5-year mortality with 95% confidence intervals (CI).
  
  
  RESULTS
  Of 1261 episodes, 735 (58.3%) were HA and 526 (41.7%) were HCA. The percentage of MRSA was 48.2% (354/735) in HA vs. 42.2% (222/526) in HCA bacteremia; p=0.04. The percentages of HCA S. aureus bacteremia and MRSA bacteremia did not vary throughout the study period. Mortality at 30 days was 40.2% (507/1261) and at 1 year was 63.4% (800/1261); this was comparable for HA and HCA bacteremia. Five-year survival curves in both settings followed very similar patterns (HR 1.01, 95% CI 0.89-1.15). Risk factors for 30-day mortality were similar, except for primary bacteremia and pre-existing heart valve disease in the HA group.
  
  
  CONCLUSIONS
  HCA S. aureus bacteremia shares many similarities with HA bacteremia with respect to the prevalence of MRSA strains, mortality rates, and risk factors for death, and should be managed similarly.
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, and Sackler School of Medicine, Tel-Aviv University, Petah-Tiqva, Israel. jihadb@clalit.org.il
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
authors.forename: Elad
authors.initials: E
authors.lastname: Goldberg
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Hila
authors.initials: H
authors.lastname: Shaked
authors.forename: Nariman
authors.initials: N
authors.lastname: Mansur
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
mesh_terms: D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007557:Israel; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D015996:Survival Rate