Abstract
BackgroundInvasive infections caused by Staphylococcus aureus have high clinical and epidemiological relevance. It is therefore important to monitor the S. aureus trends using suitable methods.AimThe study aimed to describe the trends of bloodstream infections (BSI) caused by meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA) in the European Union (EU) and the European Economic Area (EEA).MethodsAnnual data on S. aureus BSI from 2005 to 2018 were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net). Trends of BSI were assessed at the EU/EEA level by adjusting for blood culture set rate (number of blood culture sets per 1,000 days of hospitalisation) and stratification by patient characteristics.ResultsConsidering a fixed cohort of laboratories consistently reporting data over the entire study period, MRSA percentages among S. aureus BSI decreased from 30.2% in 2005 to 16.3% in 2018. Concurrently, the total number of BSI caused by S. aureus increased by 57%, MSSA BSI increased by 84% and MRSA BSI decreased by 31%. All these trends were statistically significant (p < 0.001).ConclusionsThe results indicate an increasing health burden of MSSA BSI in the EU/EEA despite a significant decrease in the MRSA percentage. These findings highlight the importance of monitoring antimicrobial resistance trends by assessing not only resistance percentages but also the incidence of infections. Further research is needed on the factors associated with the observed trends and on their attributable risk.
Highlights
Staphylococcus aureus bloodstream infection (BSI) has high clinical relevance and is a major public health challenge [1]
The percentage of meticillin-resistant S. aureus (MRSA) bloodstream infections (BSI) among all S. aureus BSI reported to the European Antimicrobial Resistance Surveillance Network (EARS-Net) decreased in most European Union (EU) and European Economic Area (EEA) countries [4]
Previous studies have suggested that MRSA causes additional infections rather than replaces infections caused by meticillin-susceptible S. aureus (MSSA) [5,6,7], and that MRSA and MSSA trends can differ depending on the site of infection and population characteristics [8,9,10,11]
Summary
Staphylococcus aureus bloodstream infection (BSI) has high clinical relevance and is a major public health challenge [1]. Previous studies have suggested that MRSA causes additional infections rather than replaces infections caused by meticillin-susceptible S. aureus (MSSA) [5,6,7], and that MRSA and MSSA trends can differ depending on the site of infection and population characteristics [8,9,10,11] These patterns are usually not routinely analysed by international surveillance systems, including EARS-Net, which generally focus on the percentage of S. aureus that are MRSA. Conclusions: The results indicate an increasing health burden of MSSA BSI in the EU/EEA despite a significant decrease in the MRSA percentage These findings highlight the importance of monitoring antimicrobial resistance trends by assessing resistance percentages and the incidence of infections. Further research is needed on the factors associated with the observed trends and on their attributable risk
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