Population-based epidemiology of Staphylococcus aureus bloodstream infection in Canterbury, New Zealand
Population-based epidemiology of Staphylococcus aureus bloodstream infection in Canterbury, New Zealand
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DOI：
10.1111/j.1445-5994.2009.01910.x
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发表时间：
2010-02-10
影响因子：
2.1
通讯作者：
Chambers, S. T.
中科院分区：
文献类型：
--
作者：
Huggan, P. J.;Wells, J. E.;Chambers, S. T.
背景：目前很少有报道描述金黄色葡萄球菌血流感染（SABSI）的人群发病率。目的：描述新西兰一个MRSA低流行地区SABSI的纵向发病率。1998年7月1日至2006年6月30日期间，从医院实验室鉴定出金黄色葡萄球菌。使用记录链接将来自当地和国家数据库的联合收割机信息合并到单个患者事件记录中。来自新西兰人口普查的信息被用来确定疾病的区域发病率。基于地址的剥夺措施被用来分析发病率和社会经济地位之间的关系。结果：779例SABSI患者被确定（482/779（62%）男性，297/779（38%）女性）。S.金黄色葡萄球菌菌血症每年18.5-27.3/10万。779株分离株中有3株（0.4%）为MRSA。776例完整记录的患者中有277例（36%）发生了医院获得性SABSI。778例患者中有141例（18%）在30天内死亡，235/778例（30%）在一年内死亡。比例风险生存模型与不良结局显著相关的是年龄、男性和在索引培养前一年住院超过14天。较高的社会经济地位与较低的SABSI发生率相关（校正率比0.74，95%可信区间：0.56-0.98，P = 0.007，校正年龄和性别后，比较最高和最低剥夺五分位数）。需要进一步的研究来确定这些是否有可能使SABSI发生率作为医疗保健质量指标的医院间比较无效。
Background:Few contemporary reports describe population-based incidence of Staphylcoccus aureus bloodstream infection (SABSI).Aim:To describe longitudinal incidence of SABSI in a region of New Zealand with low MRSA prevalence.Methods:Blood cultures growing S. aureus were identified from hospital laboratories between 1 July 1998 and 30 June 2006. Record linkage was used to combine information from local and national databases into a single patient event record. Information from the New Zealand census was used to determine regional incidence of disease. An address-based measure of deprivation was used to analyse the relationship between incidence and socioeconomic status. Morbidity data were not collected.Results:779 patients with SABSI were identified (482/779 (62%) male, 297/779 (38%) female). The crude incidence of S. aureus bacteraemia varied between 18.5-27.3/100 000 per annum. Three of 779 isolates (0.4%) were MRSA. Two hundred and seventy-seven of 776 (36%) patients with complete records had hospital-acquired SABSI. One hundred and forty-one of 778 patients (18%) died within 30 days and 235/778 (30%) died within a year. Proportional hazards survival models significantly associated age, male sex and more than 14 days of hospitalization in the year prior to index culture with adverse outcome. Higher socioeconomic status was associated with lower rates of SABSI (adjusted rate ratio 0.74, 95% confidence interval: 0.56-0.98, P = 0.007 after adjustment for age and sex, and comparing the highest and lowest deprivation quintiles).Conclusion:Population factors significantly influence SABSI incidence and survival. Further research is required to determine whether these have the potential to invalidate inter-hospital comparison of SABSI incidence as a measure of health-care quality.