title: Time trends in Staphylococcus aureus bacteremia, 1988-2010, in a tertiary center with high methicillin resistance rates.
abstract: BACKGROUND
  Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates.
  
  
  METHODS
  We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients).
  
  
  RESULTS
  In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010.
  
  
  CONCLUSIONS
  In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. dafna.yahav@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel. dafna.yahav@gmail.com.
authors.forename: Dafna
authors.initials: D
authors.lastname: Yahav
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Shaked
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.|Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Goldberg
authors.affiliation: Department of Medicine D, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Sharief
authors.initials: S
authors.lastname: Yassin
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel. noaeliakim@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel. noaeliakim@gmail.com.
authors.forename: Noa
authors.initials: N
authors.lastname: Eliakim-Raz
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.|Unit of Infectious Diseases, Rambam Hospital, Haifa, Israel.
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.|Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteremia; Mortality; Staphylococcus aureus; Time; Trends