A RETROSPECTIVE DESCRIPTIVE CASE SERIES ANALYSIS OF STAPHYLOCOCCUS AUREUS BACTEREMIA IN ADULTS AT CWM AND LAUTOKA HOSPITAL FROM 2015 TO 2018

Researchers: Prasad SS1, Drake Anne2, Narayan Deo3.
Key Words: Staphylococcus aureus bacteremia, MRSA, Bundle Care, Predictors of mortality and SAB
Objective: To show the incidence and mortality from Staphylococcus aureus bacteremia in Fiji and to document the use of evidence based care processes in management of Staphylococcus aureus bacteremia.
Design and Setting: Retrospective descriptive analysis of adult patients with Staphylococcus aureus bacteremia at CWM and Lautoka Hospital in Fiji from 2015 to 2018. The data were collected from microbiology registers, PATIS software and patients’ folders. The variables were incident cases of SAB, demographic parameters, 30 day mortality, evidence based care processes and endocarditis and data were entered in an excel spread sheet and analyzed with SPSS 24 and STRATA software.
Main outcomes: Trends in incidence rate, 30-day all–cause mortality and trends in evidence based care processes.
Results: 1064 cases with complete data for Staphylococcus aureus bacteremia (SAB) were available for incidence and mortality calculation; however, 592 patients folders’ were retrieved for evidence based care processes and predictors of mortality analysis. The incidence rate ranged from 86.2 to 100.0 per 100,000 in the study period. The incidence of MRSA was 3.0 per 100,000 in 2015 and 8.8 per 100,000 in 2018.The overall case fatality rate was 30.8% and showed an increasing trend. The case fatality rate in MSSA was 30.8% and 31.8% for MRSA. SAB was
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more common in males (65.1%) and I-Taukei (74.5%) ethnicity. The majority of the bacteremia were MSSA (93.4%) and were community acquired (95%).The use of bundle care was very low 161 (29.8%). The most common evidence-based care processes used on patients was appropriate antibiotics 534 (98.7%), followed by infectious disease consultation 332 (61.0%) and echocardiography 167 (30.9%). In the multivariate analysis, the factors associated with high mortality were older age (>65 years), septic shock, hospital-acquired infection, and having had IV antibiotics for less than 2 weeks.
Conclusion: Staphylococcus aureus bacteremia is very common in Fiji and results in high mortality. Current management practices are suboptimal, and so there needs to be more focus and resource allocation to curtail this deadly infection.