Abstract
BackgroundStudies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time.MethodsWe studied the burden of disease and death related to BSI in a defined geographical area of Mid-Norway, where BSI episodes were prospectively recorded by the same microbiological department during 12 consecutive years. Death from BSI was defined as death within 30 days of BSI detection. Age and sex standardized incidence and mortality rates and case fatality rates were calculated.ResultsBetween 2002 and 2013, 1995 episodes of BSI in 1719 patients aged 16 to 99 years were included. The overall incidence of BSI was 215 per 100,000 person-years. The incidence increased exponentially with age, particularly in males. The incidence increased from 205 to 223 per 100,000 person-years from 2002–07 to 2008–13. Escherichia coli was the most frequently isolated infective agent, followed by Streptococcus pneumoniae and Staphylococcus aureus. The rate of S. pneumoniae BSI decreased over time in males (on average by 9.2% annually), but not in females. The total rate of BSI microbes with acquired resistance increased slightly over time, but did not exceed 2 episodes per 100,000 person-years. The mortality of BSI was 32 per 100,000 person-years, higher in males than in females (36 vs. 28 per 100,000 person-years) and was significantly higher in old age, particularly in males. The total BSI mortality was similar in the first and second halves of the study period, but the mortality of S. pneumoniae BSI decreased in males (15.0% annually). The crude case fatality decreased from the first to the second half of the study period (17.2% to 13.1%; p = 0.014). The rate of blood culture sampling increased more than twofold during the study period.ConclusionsThe mortality of BSI remained stable during 2002–2013. At the same time, BSI incidence increased and case fatality rate decreased, perhaps because an increased rate of blood culture sampling may have led to improved detection of milder BSI episodes. Very low, yet slightly increasing rates of microbes with acquired resistance were observed.
Highlights
Studies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time
Incidence rates allover and by sex and age The overall incidence rate of BSI was 215 per 100,000 person-years (Table 1), and the rate was higher in males than in females
The present study provides information on the incidence and mortality of BSI in an area of Mid-Norway, overall, by age and sex, by time period, and for specific subgroups of BSI
Summary
Studies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time. Bloodstream infection (BSI) contributes substantially to morbidity and mortality worldwide [1]. Most studies report increasing incidence rates [5, 6, 8], but a decreasing rate has been described [10]. The burden of BSI includes mortality as well as incidence, but few studies have reported both [1, 3, 6]. Monitoring the burden of BSI is important for reasons of resource allocation and for evaluating prevention and treatment strategies [11]. Growing antimicrobial resistance worldwide, associated with increased mortality [14, 15], make surveillance of BSI microbes and antimicrobial resistance essential.
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