S. aureus Infections in US Veterans, CME Activity | CDC EID

EID Journal Home > Volume 17, Number 3–March 2011

Volume 17, Number 3–March 2011
MEDSCAPE CME ACTIVITY
Staphylococcus aureus Infections in US Veterans, Maryland, USA, 1999–2008

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscape.org/journal/eid; (4) view/print certificate.

Release date: February 25, 2011; Expiration date: February 25, 2012

Learning Objectives
Upon completion of this activity, participants will be able to:

•Describe the change in overall incidence of S. aureus infections between fiscal years 1999 and 2008 based on a retrospective cohort study using patient-level data in the Veterans Affairs Maryland Healthcare System
•Describe trends in invasive vs noninvasive S. aureus infections, changes in methicillin susceptibility, and changes in location of onset and infection site between fiscal years 1999 and 2008 based on the aforementioned study
•Describe hospital infection-control practices that may contribute to declining incidence of invasive S. aureus infections


Medscape CME Editor
Karen L. Foster, MA, Technical Writer-Editor, Emerging Infectious Diseases. Karen L. Foster, MA, has disclosed no relevant financial relationships.


Medscape CME Author
Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


Authors
Disclosures: LaRee A. Tracy, MA, PhD; Jon P. Furuno, PhD; Mary Singer, PhD, MD; Patricia Langenberg, PhD; and Mary-Claire Roghmann, MD, MS, have disclosed no relevant financial relationships. Anthony D. Harris, MD, MPH, has disclosed the following relevant financial relationship: served as an advisor or consultant for Ansell on a retrospective database project.

open here to see the full-text or see below:
S. aureus Infections in US Veterans, CME Activity | CDC EID

EID Journal Home > Volume 17, Number 3–March 2011

Volume 17, Number 3–March 2011
Research
Staphylococcus aureus Infections in US Veterans, Maryland, USA, 1999–20081
LaRee A. Tracy, Jon P. Furuno, Anthony D. Harris, Mary Singer, Patricia Langenberg, and Mary-Claire Roghmann
Author affiliations: University of Maryland, Baltimore, Maryland, USA (L.A. Tracy, J.P. Furuno, A.D. Harris, P. Langenberg, M.-C. Roghmann); Veterans Administration Maryland Health Care System, Baltimore (M.-C. Roghmann); and US Food and Drug Administration, Silver Spring, Maryland, USA (M. Singer)

Suggested citation for this article

Abstract
Trends in Staphylococcus aureus infections are not well described. To calculate incidence in overall S. aureus infection and invasive and noninvasive infections according to methicillin susceptibility and location, we conducted a 10-year population-based retrospective cohort study (1999–2008) using patient-level data in the Veterans Affairs Maryland Health Care System. We found 3,674 S. aureus infections: 2,816 (77%) were noninvasive; 2,256 (61%) were methicillin-resistant S. aureus (MRSA); 2,517 (69%) were community onset, and 1,157 (31%) were hospital onset. Sixty-one percent of noninvasive infections were skin and soft tissue infections; 1,112 (65%) of these were MRSA. Ten-year averaged incidence per 100,000 veterans was 749 (± 132 SD, range 549–954) overall, 178 (± 41 SD, range 114–259) invasive, and 571 (± 152 SD, range 364–801) noninvasive S. aureus infections. Incidence of all S. aureus infections significantly increased (p<0.001), driven by noninvasive, MRSA, and community-onset infections (p<0.001); incidence of invasive S. aureus infection significantly decreased (p<0.001).

Staphylococcus aureus exists as a commensal organism living on the human body in equilibrium with other bacteria and as a common agent associated with a spectrum of diseases ranging from mild, noninvasive skin and soft tissue infections (SSTIs) to invasive, life-threatening bloodstream infections. Increasing incidence of infections caused by methicillin-resistant S. aureus (MRSA) has complicated treatment of S. aureus infection. Previously MRSA infections were problematic primarily among hospitalized persons or persons exposed to the health care settings. However, since the 1990s, MRSA infections have become more prevalent in healthy, younger persons who have little to no exposure to health care settings. Of particular concern is the rapid increase in MRSA SSTIs reportedly driven by emergence of a new MRSA strain, USA300 (1,2).

Despite these changes, the epidemiology of S. aureus infection, particularly the total effect of infection in the United States, is not well described. Several population-based studies on S. aureus infections exist; however, these studies focused on hospital-based populations (3–6), MRSA infection (7–9), non-US populations (10–12), or only estimated the impact of invasive S. aureus disease (10,13–15). Additionally, population-level changes in incidence, particularly before and after USA300 MRSA emerged, are largely unknown. To describe overall trends and recent changes in the incidence of S. aureus infection while differentiating between invasive and noninvasive, community- and hospital-onset, and methicillin-susceptible and -resistant S. aureus infections, we conducted a retrospective population-based study.

Suggested Citation for this Article
Tracy LA, Furuno JP, Harris AD, Singer M, Langenberg P, Roghmann M-C. Staphylococcus aureus infections in US veterans, Maryland, USA, 1999–2008. Emerg Infect Dis [serial on the Internet]. 2011 Mar [date cited]. http://www.cdc.gov/EID/content/17/3/441.htm

DOI: 10.3201/eid1703.100502



1This study was presented in part at the 49th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; 2009 Sep 11–15; San Francisco, California, USA (abstracts 1217 and 3136).


Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

LaRee A. Tracy, University of Maryland, Department of Epidemiology and Public Health, 685 W Baltimore St, MSTF 336, Baltimore, MD 21201, USA; email: laree.tracy@fda.hhs.gov



open here to see the full-text (large size):
S. aureus Infections in US Veterans, CME Activity | CDC EID