title: Staphylococcus aureus bacteraemia in Gauteng academic hospitals, South Africa.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible for longer hospital stays, increased hospital costs, and poorer outcomes compared to methicillin-sensitive S. aureus (MSSA) infections. We aimed to describe the epidemiology of S. aureus bacteraemia (SAB) and to determine factors associated with MRSA infection in South Africa.
  
  
  METHODS
  Cases of SAB were reported from September 2012 to September 2013 from three sentinel sites. A case was defined as the isolation of S. aureus from a blood culture during a 21-day period. Detailed clinical information was collected. Multivariable logistic regression was done to determine factors associated with MRSA infection and mortality.
  
  
  RESULTS
  There were 442 cases of SAB reported; antimicrobial susceptibility testing was performed on 240 isolates (54%). Thirty-six percent (86/240) of cases had an MRSA infection. A longer hospital stay before positive specimen collection (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02-1.13, p=0.004), hospitalization in the last year (OR 15.7, 95% CI 2.5-99.5, p=0.003), HIV infection (OR 4.9, 95% CI 1.05-22.90, p=0.044), and antibiotic use in the previous 2 months (OR 0.1, 95% CI 0.01-0.68, p=0.022) were independent predictors of MRSA. Older age, and in particular age 25-44 years (OR 22.2, 95% CI 2.7-185.5, p=0.004, compared to those aged<5 years), was the only independent predictor of mortality amongst cases with SAB. MRSA isolates were non-susceptible to more antimicrobial agents compared to MSSA isolates.
  
  
  CONCLUSIONS
  HIV infection was an independent risk factor for MRSA infection. The selection of appropriate empirical antimicrobial treatment is essential in patients with MRSA infections because of non-susceptibility to many other antimicrobial classes.
authors.affiliation: National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa.
authors.forename: Melony C
authors.initials: MC
authors.lastname: Fortuin-de Smidt
authors.affiliation: National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Ashika
authors.initials: A
authors.lastname: Singh-Moodley
authors.affiliation: National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa.
authors.forename: Rubeina
authors.initials: R
authors.lastname: Badat
authors.affiliation: National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Quan
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Ranmini
authors.initials: R
authors.lastname: Kularatne
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Trusha
authors.initials: T
authors.lastname: Nana
authors.affiliation: Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division, National Health Laboratory Service, Gauteng, South Africa.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lekalakala
authors.affiliation: National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nelesh P
authors.initials: NP
authors.lastname: Govender
authors.affiliation: National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: olgap@nicd.ac.za.
authors.forename: Olga
authors.initials: O
authors.lastname: Perovic
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D055815:Young Adult
keywords: Bacteraemia; HIV infection; Methicillin-resistant; Mortality; Staphylococcus aureus