title: A major reduction in hospital-onset Staphylococcus aureus bacteremia in Australia-12 years of progress: an observational study.
abstract: BACKGROUND
  Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years.
  
  
  METHODS
  An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus strains.
  
  
  RESULTS
  A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86-.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50-1.97) to 0.64 per 10 000 PDs (95% CI, .53-.76) in 2013. The mean reduction per year was 9.4% (95% CI, -8.1% to -10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed.
  
  
  CONCLUSIONS
  There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare-associated infections have been very successful.
authors: Faculty of Nursing and Health, Avondale College for Higher Education, Wahroonga, New South Wales School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Dickson.
authors: Brett G
authors: BG
authors: Mitchell
authors: Canberra Hospital and Medical School, Australian National University, Canberra, Australian Capital Territory.
authors: Peter J
authors: PJ
authors: Collignon
authors: Healthcare Associated Infection Unit, Department of Health, Perth, Western Australia.
authors: Rebecca
authors: R
authors: McCann
authors: Infection Control Service, Department of Health, Adelaide, South Australia.
authors: Irene J
authors: IJ
authors: Wilkinson
authors: Tasmanian Infection Prevention and Control Unit, Department of Health and Human Services, Hobart, Tasmania, Australia.
authors: Anne
authors: A
authors: Wells
mesh_terms: D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D001769:Blood / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006761:Hospitals; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D008137:Longitudinal Studies; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification
keywords: Staphylococcus aureus; bacteremia; bloodstream infection; healthcare-associated infections; infection control