Secular changes in incidence and mortality associated with Staphylococcus aureus bacteraemia in Quebec, Canada, 1991-2005.

In order to examine secular changes in the incidence and mortality associated with Staphylococcus aureus bacteraemia before and after the emergence of methicillin-resistant S. aureus (MRSA), a retrospective cohort study of 815 patients with S. aureus bacteraemia was performed in the Estrie region of Quebec, Canada, between 1991 and 2005. The primary outcome was all-cause 30-day mortality. Between 1991-1993 and 2003-2005, the proportion of cases attributed to endocarditis and pneumonia increased from 4% to 11% and from 2% to 11%, respectively, while that attributed to catheter infections decreased from 49% to 17%. MRSA was almost absent in 1991-1999, but accounted for 10% and 20% of cases in 2000-2002 and 2003-2005, respectively. The population incidence of bacteraemia caused by methicillin-susceptible S. aureus (MSSA) remained stable between 1997 and 2005, while that of MRSA increased from 0 to 7.4/100 000. Risk-factors for mortality included age, co-morbidities, female gender, residence outside the city of Sherbrooke, pneumonia (OR 3.35, 95% CI 1.96-5.73) or endocarditis (OR 2.89, 95% CI 1.67-5.01) as the source, and an absence of treatment. After adjusting for confounders, patients with MRSA bacteraemia had a higher mortality rate than those with MSSA bacteraemia (OR 2.21, 95% CI 0.99-4.96, p 0.053). Mortality in patients with MSSA bacteraemia was 19% (16/83) in 1991-1993, 23% (26/113) in 1994-1996, 29% (50/173) in 1997-1999, and 28% (52/185) in 2000-2002, decreasing to 15% (28/192) in 2003-2005, which impacted on the relative mortality rates of MRSA and MSSA. MRSA did not replace, but added to, an existing stable incidence of MSSA bacteraemia.     

Secular changes in incidence and mortality associated with Staphylococcus aureus bacteraemia in Quebec, Canada, 1991–2005

In order to examine secular changes in the incidence and mortality associated with Staphylococcus aureus bacteraemia before and after the emergence of methicillin-resistant S. aureus (MRSA), a retrospective cohort study of 815 patients with S. aureus bacteraemia was performed in the Estrie region of Quebec, Canada, between 1991 and 2005. The primary outcome was all-cause 30-day mortality. Between 1991–1993 and 2003–2005, the proportion of cases attributed to endocarditis and pneumonia increased from 4% to 11% and from 2% to 11%, respectively, while that attributed to catheter infections decreased from 49% to 17%. MRSA was almost absent in 1991–1999, but accounted for 10% and 20% of cases in 2000–2002 and 2003–2005, respectively. The population incidence of bacteraemia caused by methicillin-susceptible S. aureus (MSSA) remained stable between 1997 and 2005, while that of MRSA increased from 0 to 7.4/100 000. Risk-factors for mortality included age, co-morbidities, female gender, residence outside the city of Sherbrooke, pneumonia (OR 3.35, 95% CI 1.96–5.73) or endocarditis (OR 2.89, 95% CI 1.67–5.01) as the source, and an absence of treatment. After adjusting for confounders, patients with MRSA bacteraemia had a higher mortality rate than those with MSSA bacteraemia (OR 2.21, 95% CI 0.99–4.96, p 0.053). Mortality in patients with MSSA bacteraemia was 19% (16/83) in 1991–1993, 23% (26/113) in 1994–1996, 29% (50/173) in 1997–1999, and 28% (52/185) in 2000–2002, decreasing to 15% (28/192) in 2003–2005, which impacted on the relative mortality rates of MRSA and MSSA. MRSA did not replace, but added to, an existing stable incidence of MSSA bacteraemia.     

Mortality from asthma in children and young adults in Louisiana.

BACKGROUND: Asthma mortality rates have been increasing despite our improved understanding of the pathophysiology of asthma and advanced methods of treatment. Although there are many national studies of asthma mortality rates, few studies have concentrated on subnational regions such as individual states. OBJECTIVES: We sought to determine the trends in asthma mortality in children and young adults during the last 15 years in Louisiana. METHODS: Asthma mortality data were acquired from the Louisiana State Center for Health Statistics for the years 1983 through 1997. All asthma deaths coded International Classification of Disease, Ninth Revision 493 were included in the data set along with year, sex, and rate characteristics. State population estimates obtained from the United States Bureau of Census for three 5-year periods (1983 to 1987, 1988 to 1992, and 1993 to 1997) were used to calculate crude and adjusted mortality rates. These time periods were compared with one another and with the period 1983 to 1987, which was used as a baseline. RESULTS: For all residents, the mortality rate increased from 0.41 deaths per 100,000 persons during the 1983 to 1987 time period to 0.49 and 0.63 deaths per 100,000 persons during 1988 to 1992 and 1993 to 1997 time periods, respectively. Mortality rates have increased in both the white and non-white populations over the 15-year study period, with the most pronounced increases among the non-white population. CONCLUSION: Asthma mortality rates in Louisiana have increased, particularly among the non-white population, over the last 15 years, although the results are not statistically significant. When compared with other states, asthma mortality in Louisiana is lower than in the northeast and central north states.     

Cancer Statistics in Korea: Incidence, Mortality and Survival in 2005

Cancer has been the most common cause of death in Korea since 1983 and is a major public health concern. This paper overviews the nationwide cancer statistics, including incidence, mortality, and survival rates, and their trends in Korea. In 2005, 142,610 new cancer cases and 65,117 cancer deaths occurred in Korea. The incidence rate for all cancer combined increased by 2.6% annually from 1999 to 2005. Significant increases have occurred in the incidence of colorectal, thyroid, female breast, and prostate cancers. The number of cancer deaths has increased over the past two decades, due mostly to population aging, while the age-standardized mortality rates have decreased in both men and women since 2002. Notable improvement has been observed in the 5-yr relative survival rates for most major cancers and for all cancer combined, with the exception of pancreatic cancer. The nationwide cancer statistics in this paper will provide essential data for evidence-based decisions in the national cancer control program in Korea.     

Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000

Staphylococcus aureus is a leading cause of bacteraemia. This study analysed temporal trends from 18,702 adult cases of S. aureus bacteraemia in Denmark between 1981 and 2000. After stratification for mode of acquisition, 57% of cases were hospital-acquired (HA), 28% were community-acquired (CA) and 15% were of undetermined acquisition (UA). Incidence rates increased from 18.2 to 30.5 cases/100,000 population. Annual rates increased by 6.4% for CA, by 2.2% for HA and by 3.6% for UA cases, respectively. Case-mortality associated with HA bacteraemia decreased from 36.2% to 20.7% (43% rate reduction, p 0.0001), compared with a decrease from 34.5% to 26.5% (23% rate reduction, p 0.0001) for CA bacteraemia. Following multivariate analysis, age, pneumonia, endocarditis and chronic illness were associated with increased mortality, regardless of the mode of acquisition. Overall, mortality associated with S. aureus bacteraemia declined significantly between 1981 and 2000, but incidence rates doubled, so that the total number of deaths increased. These data emphasise the public health importance of S. aureus bacteraemia and the need for further preventive measures and improved care in order to reduce incidence rates and improve outcomes.     

Control of methicillin-resistantStaphylococcus aureus bacteraemia in high-risk areas

In a 3,000-bed tertiary care hospital, 88 cases of methicillin-resistantStaphylococcus aureus (MRSA) bacteraemia were identified from 22,383 blood cultures (0.39 %) submitted to the microbiology laboratory over a one-year period. Two high-risk areas were identified: the paediatric oncology unit, in which 12 cases of MRSA bacteraemia were identified from 924 blood cultures (1.3 %), and the intensive care unit (ICU), in which 14 cases of MRSA bacteraemia were identified from 1,391 blood cultures (1.0 %). In a one-year targeted intervention programme in which staff and patients were screened for MRSA carriage, patient carriers isolated, and mupirocin and chlorhexidine treatment administered, the number of MRSA bacteraemia cases decreased in these areas to 0 and 4, respectively (p=0.000123 and 0.016), while the incidence of MRSA bacteraemia in non-targeted areas increased from 62 of 20,068 blood cultures (0.3 %) to 82 of 18,784 blood cultures (0.44 %) (p=0.047). In the year post intervention the incidence of MRSA bacteraemia increased to 3 of 815 cultures (0.37 %) in the paediatric oncology unit, 10 of 1,934 cultures (0.5 %) in the ICU, and 112 of 18,977 cultures (0.59 %) in the rest of the hospital (p=0.00004 versus preintervention period). This study demonstrates the efficacy of targeted MRSA control measures in a hospital in which MRSA is endemic.     

Case–control study to identify factors associated with mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with increased mortality. Delay in appropriate antimicrobial therapy (DAAT) is an important risk factor for death, although confounding between carriage of MRSA and DAAT has not been resolved. We studied the association of risk factors with mortality and searched for specific populations vulnerable to DAAT. We conducted a case–control study comparing patients with MRSA bacteraemia who died during hospitalization (cases) with patients with MRSA bacteraemia who survived (controls) in three medical centres in two states. Patients were identified using computerized hospital databases for the years 2001–2005. Medical records were retrieved and various epidemiological data extracted. Bivariate and multivariate logistic regression analyses were performed. Overall, 388 patients with MRSA bacteraemia were included, 164 cases and 224 controls. According to bivariate analyses, cases were significantly more likely than controls to (i) be older (>65 years), (ii) have transferred from an institution, (iii) have stayed in an ICU, (iv) have had more invasive devices, (v) have a poorer prognosis on admission, (vi) have higher disease severity at the time of bacteraemia, and (vii) have a DAAT of ≥2 days. Upon multivariate analysis, among patients >65 years, DAAT was significantly associated with increased mortality (p 0.04). Furthermore, patients >65 years with severe sepsis were much more likely to experience DAAT (p 0.02). In elderly patients with MRSA bacteraemia, DAAT is associated with increased mortality. Moreover, advanced age is a predictor for DAAT. These significant epidemiological associations mandate early coverage of MRSA in septic elderly patients.     

Cancer Statistics in Korea: Incidence, Mortality and Survival in 2006-2007

Cancer has been the leading cause of death in Korea. Korea is facing a very rapid change and increase in cancer incidence, which draws much attention in public health. This paper overviews the nationwide cancer statistics, including incidence, mortality, and survival rates, and their trends in Korea based on the cancer incidence data from The Korea Central Cancer Registry (KCCR) in year 2006 and 2007. In Korea, there were 153,237 cancer cases and 65,519, cancer deaths observed in 2006, and 161,920 cancer cases and 67,561 cancer deaths in 2007, respectively. The incidence rate for all cancer combined showed an annual increase of 2.8% from 1999 to 2007. Specifically, there was significant increase in the incidence of colorectal, thyroid, female breast, and prostate cancers. The number of cancer deaths has increased over the past two decades, due mostly to population aging, while the age-standardized mortality rates have decreased in both men and women since 2002. Notable improvement has been observed in the 5-yr relative survival rates for most major cancers and for all cancer combined, with the exception of pancreatic cancer. The nationwide cancer statistics in this paper will provide essential data for cancer research and evidence-based health policy in Korea.     

Methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> bacteraemia and mortality in a teaching hospital

Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for more than 40% of S. aureus bacteraemias in the UK and is associated with considerable morbidity and mortality. This retrospective audit examined the epidemiology of MRSA bacteraemia (MRSAB) at our institution, where the MRSAB rate has been high. A retrospective case note review was undertaken of all patients dying within 90 days of an episode of MRSAB during a 12-month period. A clinical panel classified deaths as having MRSAB as the main cause, contributing cause or having no bearing on the death. Sixty-two patients had one or more episodes of MRSAB and 30 died within 90 days. The mean age of those dying was 72 (43–96) years and of those surviving was 57 (21–87) years. MRSAB was judged to be the main or contributing cause of death in 24 cases, giving an associated mortality of 39%. All-cause mortality at 7, 30 and 90 days was 19, 40 and 48%, respectively. We investigated the minimum inhibitory contribution (MIC) to vancomycin for 79 MRSAB isolates, of which 70.8% of isolates had an MIC value of 2 mg/l. None of the isolates expressed heteroresistance to vancomycin. Five out of seven patients in whom MRSAB was the main cause of death had community onset of infection. It is unlikely that efforts to reduce delays in delivering effective antimicrobial therapy will have a major impact on mortality. Efforts to reduce the burden of MRSAB should focus on the primary prevention of bacteraemia.     

Trends in AIDS and mortality in HIV-infected subjects with hemophilia from 1985 to 2003: the competing risks for death between AIDS and liver disease

OBJECTIVE: To study trends in progression to AIDS, all-cause mortality, and cause-specific mortality (AIDS-related, liver disease, and hemorrhagic complications) over calendar periods with different exposure to highly active antiretroviral therapy (HAART) in a cohort of hemophiliacs in Spain, taking into account the competing risks of the causes of death. METHODS: Multicenter cohort of HIV-infected hemophiliacs. HIV seroconversion was estimated using mathematic techniques for interval-censored data from 1979 through 1985. Rates of AIDS and cause-specific death were calculated by Poisson regression, allowing for late entry, for the periods 1985 through 1992, 1993 through 1996, 1997 through 2000 (early HAART), and 2001 through 2003 (late HAART), also allowing for competing risks. RESULTS: Of 585 subjects, 44% were younger than 15 years of age, 82% had severe hemophilia, 86% had type A hemophilia, and the median seroconversion date was October 1982. Calendar period and age at HIV seroconversion strongly influenced AIDS and death rates. Compared with 1993 through 1996, decreases of 75% (relative risk [RR] = 0.25, 95% confidence interval [CI]: 0.14 to 0.43) and 72% (RR = 0.28, 95% CI: 0.12 to 0.63) in the RR of AIDS were observed in early and late HAART. For all-cause mortality, 72% (RR = 0.28, 95% CI: 0.18 to 0.42) and 83% (RR = 0.17, 95% CI: 0.09 to 0.33) decreases were observed by 1997 through 2000 and 2001 through 2003. For liver-related deaths, increases were observed in the late-HAART period (RR = 2.80, 95% CI: 0.94 to 8.36) compared with 1993 through 1996, but using competing risks, this RR was substantially reduced (RR = 1.70, 95% CI: 0.57 to 5.04). DISCUSSION: Major reductions in AIDS and death rates were observed from 1997 to 2003 in hemophiliacs. These survival improvements are largely attributable to decreases in AIDS-related deaths and have been accompanied by increases in liver disease death rates, which are overestimated if competing risks are not taken into account.     

Trends in mortality and hospital admissions associated with epilepsy in England and Wales during the 1990s

This article examines trends in mortality and hospital admissions associated with epilepsy in England and Wales during the 1990s. Mortality data were analysed for the period 1993 to 2000. Data on hospital admissions where the main diagnosis was epilepsy were obtained from the Hospital Episode Statistics information service of the Department of Health and analysed for the period 1991/92 to 2000/01. There were about 800 deaths per year where epilepsy was the underlying cause and about 37,000 admissions where epilepsy was the main diagnosis. Both mortality and hospital admission rates for epilepsy remained relatively stable during the periods examined.     

Trends in deaths related to drug misuse in England and Wales, 1993-2004

In this article we report trends in deaths related to drug misuse in England and Wales from 1993 to 2004, looking particularly at the period between 1999 and 2004, for which there was a Government target to reduce these deaths by 20 per cent. Although there was an overall decline in deaths related to drug misuse between 1999 and 2004, the percentage reduction, at 9 per cent, was less than the Government target. There was an increase in deaths between 2003 and 2004, largely accounted for by deaths involving heroin/methadone and morphine. Mortality rates were highest in young adults and an increase in mortality rates within this group appears to have been the driver behind rising mortality trends during the 1990s.     

Trends in mortality from Alzheimer's disease, Parkinson's disease and dementia, England and Wales, 1979-2004

In this article we present trends in mortality from Alzheimer's disease, Parkinson's disease and dementia in England and Wales from 1979 to 2004. We describe the impact of mortality coding changes on the underlying cause of death, particularly the introduction of ICD-10 in 2001. We present rates for all mentions of the conditions on death certificates to interpret trends better. Mortality rates for the three conditions showed varying trends over the time period examined. Between 1985 and 2004, Alzheimer's disease showed a dramatic increase. Trends in mentions of dementia differed between males and females, with rates being relatively stable among males, but increasing among females. Rates for Parkinson's disease declined over this period.     

Height and mortality in the counties of England and Wales

Average heights of adults and children in the counties of England and Wales were examined using national samples of people born between 1920 and 1970. Although height increased over this 50-year period the differences between counties persisted. Average height in a county is closely related to its pattern of death rates, which were derived from all deaths during 1968-78. Counties with taller populations have lower mortality from chronic bronchitis, rheumatic heart disease, ischaemic heart disease and stroke, and higher mortality from three hormone-related cancers, of the breast, prostate and ovary. The inverse relation of height with bronchitis and cardiovascular disease is further evidence of risk factors acting in early childhood. The positive relation between height and cancers of the breast, ovary and prostate could suggest that promotion of child growth has disadvantages as well as benefits.     

Predictors of clinical and microbiological treatment failure in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: a retrospective cohort study in a region with low MRSA prevalence

Invasive infections with methicillin-resistant Staphylococcus aureus (MRSA) have been associated with increased morbidity and mortality. The aim of the present study was to identify independent predictors of early mortality and treatment failure in patients with MRSA bacteraemia. A total of 132 adult patients who developed MRSA bacteraemia during hospitalization in the University Hospital of Vienna between 2000 and 2011 were screened and 124 were included in a retrospective cohort study. Patient demographics, source of bacteraemia, antimicrobial treatment and microbiological characteristics were evaluated. The 28-day crude mortality was 30.6%. Predictors of early mortality identified in multivariate Cox regression analysis included higher patientage (adjusted hazard ratio (aHR) 1.03, 95% CI 1.01–1.06, p 0.006), pneumonia (aHR 3.86, 95% CI 1.83–8.12, p <0.001) and failure to use MRSA active treatment (aHR 8.77, 95% CI 3.50–21.93, p <0.001). Ninety-one (73.4%) patients received glycopeptides as specific MRSA treatment. Of 63 patients treated with vancomycin, only 14 (22.6%) patients had aimed trough levels of 15–20 mg/L. Vancomycin MIC ≥ 2 mg/L was detected in 28.2% and was associated with glycopeptide pretreatment (p 0.001). All MRSA isolates were susceptible to linezolid and tigecycline. Persistent bacteraemia ≥ 7 days was documented in 25 (20.2%) patients. Independent determinants for microbiological eradication failure in patients with MRSA bacteraemia included endocarditis (p <0.001) and vancomycin trough levels (p 0.014), but not vancomycin MIC. Failure of clinical and microbiological eradication of MRSA among patients with MRSA bacteraemia was associated with clinical entity rather than with bacterial traits. Pharmacokinetic parameters seem to be decisive on microbiological and clinical success.     

Community-associated versus healthcare-associated methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> bacteraemia: a 10-year retrospective review

The objective was to compare the epidemiology and outcome of healthcare- (HA-) and community-associated (CA-) MRSA bacteraemia. A 10-year retrospective study of MRSA bacteraemia was carried out. Episodes were classified according to established criteria. Molecular typing was performed on a subset of isolates. Of 197 MRSA bacteraemia episodes, 178 (90.4%) were classified as HA-MRSA and 19 (9.6%) as CA-MRSA. All-cause 7- and 30-day mortality rates were similar in the HA and CA-MRSA bacteraemia groups; however, 1-year mortality was higher in the HA-MRSA bacteraemia group (48.3% vs 21.1% [p = 0.023]). Thirty-day all-cause mortality was significantly lower if empiric antimicrobial therapy included agent(s) to which the isolate tested susceptible, compared with patients receiving “inactive” therapy (19% vs 35.1% [p = 0.011]). The majority of MRSA bacteraemia episodes were caused by clones known to circulate in the community. All-cause mortality is as high in HA- as in CA-MRSA bacteraemia. Thirty-day mortality was significantly reduced if the patient received an antibiotic with activity against the MRSA isolate. Results presented in part at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, IL, 17–20 September 2007.     

Mortality experience of Tsimane Amerindians of Bolivia: regional variation and temporal trends.

This paper examines regional and temporal trends in mortality patterns among the Tsimane, a population of small-scale forager-horticulturalists in lowland Bolivia. We compare age-specific mortality in remote forest and riverine regions with that in more acculturated villages and examine mortality changes among all age groups over the past 50 years. Discrete-time logistic regression is used to examine impacts of region, period, sex, and age on mortality hazard. Villages in the remote forest and riverine regions show 2-4 times higher mortality rates from infancy until middle adulthood than in the acculturated region. While there was little change in mortality for most of the life course over the period 1950-1989, overall life expectancy at birth improved by 10 years from 45 to 53 after 1990. In both periods, over half of all deaths were due to infectious disease, especially respiratory and gastrointestinal infections. Accidents and violence accounted for a quarter of all deaths. Unlike typical patterns described by epidemiologic transition theory, we find a much larger period reduction of death rates during middle and late adulthood than during infancy or childhood. In the remote villages, infant death rates changed little, whereas death rates among older adults decreased sharply. We hypothesize that this pattern is due to a combination of differential access to medical interventions, a continued lack of public health infrastructure and Tsimane cultural beliefs concerning sickness and dying.     

Case fatality ratio and mortality rate trends of community-onset Staphylococcus aureus bacteraemia

Lethal outcomes can be expressed as a case fatality ratio (CFR) or as a mortality rate per 100 000 population per year (MR). Population surveillance for community-onset methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus bacteraemia was conducted in Canada, Australia, Sweden and Denmark to evaluate 30-day CFR and MR trends between 2000 and 2008. The CFR was 20.3% (MSSA 20.2%, MRSA 22.3%) and MR was 3.4 (MSSA 3.1, MRSA 0.3) per 100 000 per year. Although MSSA CFR was stable the MSSA MR increased; MRSA CFR decreased while its MR remained low during the study. Community-onset S. aureus bacteraemia, particularly MSSA, is associated with major disease burden. This study highlights complementary information provided by evaluating both CFR and MR.