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. 2020 Jan 1;70(1):19-25.
doi: 10.1093/cid/ciz158.

Trends in Incidence of Methicillin-resistant Staphylococcus aureus Bloodstream Infections Differ by Strain Type and Healthcare Exposure, United States, 2005-2013

Isaac See  1 , Yi Mu  1 , Valerie Albrecht  1 , Maria Karlsson  1 , Ghinwa Dumyati  2 , Dwight J Hardy  2 , Mackenzie Koeck  3 , Ruth Lynfield  3 , Joelle Nadle  4 , Susan M Ray  5 , William Schaffner  6 , Alexander J Kallen  1
Affiliations

Trends in Incidence of Methicillin-resistant Staphylococcus aureus Bloodstream Infections Differ by Strain Type and Healthcare Exposure, United States, 2005-2013

Isaac See et al. Clin Infect Dis. .

Abstract

Background: Previous reports suggested that US methicillin-resistant Staphylococcus aureus (MRSA) strain epidemiology has changed since the rise of USA300 MRSA. We describe invasive MRSA trends by strain type.

Methods: Data came from 5 Centers for Disease Control and Prevention Emerging Infections Program sites conducting population-based surveillance and collecting isolates for invasive MRSA (ie, from normally sterile body sites), 2005-2013. MRSA bloodstream infection (BSI) incidence per 100 000 population was stratified by strain type and epidemiologic classification of healthcare exposures. Invasive USA100 vs USA300 case characteristics from 2013 were compared through logistic regression.

Results: From 2005 to 2013, USA100 incidence decreased most notably for hospital-onset (6.1 vs 0.9/100 000 persons, P < .0001) and healthcare-associated, community-onset (10.7 vs 4.9/100 000 persons, P < .0001) BSIs. USA300 incidence for hospital-onset BSIs also decreased (1.5 vs 0.6/100 000 persons, P < .0001). However, USA300 incidence did not significantly change for healthcare-associated, community-onset (3.9 vs 3.3/100 000 persons, P = .05) or community-associated BSIs (2.5 vs 2.4/100 000 persons, P = .19). Invasive MRSA was less likely to be USA300 in patients who were older (adjusted odds ratio [aOR], 0.97 per year [95% confidence interval {CI}, .96-.98]), previously hospitalized (aOR, 0.36 [95% CI, .24-.54]), or had central lines (aOR, 0.44 [95% CI, .27-.74]), and associated with USA300 in people who inject drugs (aOR, 4.58 [95% CI, 1.16-17.95]).

Conclusions: Most of the decline in MRSA BSIs was from decreases in USA100 BSI incidence. Prevention of USA300 MRSA BSIs in the community will be needed to further reduce burden from MRSA BSIs.

Keywords: MRSA; bloodstream infections; epidemiology; infection control; strains.

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Conflict of interest statement

Potential conflicts of interest. W. S. has received personal fees from Pfizer, Merck, Dynavax, SutroVax, Shionogi, and Seqirus. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Estimated incidence of hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections, by strain type, in 5 Emerging Infections Program sites, 2005–2013. Cases are considered hospital-onset if the initial culture was obtained on the fourth day or later during a hospital admission. Error bars represent the minimum and maximum incidence rates among imputation datasets.
Figure 2.
Figure 2.
Estimated incidence of healthcare-associated, community-onset methicillin-resistant Staphylococcus aureus bloodstream infections, by strain type, in 5 Emerging Infections Program sites, 2005–2013. Cases are considered healthcare-associated, community-onset if the culture was obtained either from an outpatient or during the first 3 days of a hospital admission, from a patient with at least 1 of the following healthcare risk factors: hospital admission, long-term care facility residence, dialysis, or surgery within the prior year; or central venous catheter within 2 days prior to the culture. Error bars represent the minimum and maximum incidence rates among imputation datasets.
Figure 3.
Figure 3.
Estimated incidence of community-associated methicillin-resistant Staphylococcus aureus bloodstream infections, by strain type, in 5 Emerging Infections Program sites, 2005–2013. Cases are considered community-associated if the culture was obtained either from an outpatient or during the first 3 days of a hospital admission, from a patient without any of the following healthcare risk factors: hospital admission, long-term care facility residence, dialysis, or surgery within the prior year; or central venous catheter within 2 days prior to the culture. Error bars represent the minimum and maximum incidence rates among imputation datasets.
Figure 4.
Figure 4.
Proportion of clinical infections associated with invasive methicillin-resistant Staphylococcus aureus cases due to USA300 (vs USA100) strain type, in 5 Emerging Infections Program sites, 2013. Cases with cellulitis, pneumonia, and skin abscess had an underlying invasive specimen source (eg, positive blood culture). The vertical error bars depict the corresponding 95% confidence intervals.
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