The same but different: a comparison of Staphylococcus aureus bloodstream infections in metropolitan and non-metropolitan hospitals (2010-2020)

Intern Med J. 2021 Sep 22. doi: 10.1111/imj.15538. Online ahead of print.

ABSTRACT

BACKGROUND: Variation of infection rates between hospitals must be identified; differences may highlight opportunities for quality improvement in healthcare delivery to specific hospitals groups.

AIM: To analyse burden, time-trends and risks of healthcare associated (HA) Staphylococcus aureus bloodstream infections (SABSI) in patients admitted to Victorian metropolitan and non-metropolitan public acute care hospitals.

METHODS: SABSI surveillance data submitted between 1 July 2010 and 30 June 2020 by all 118 Victorian public acute care hospitals were analysed. Aligned with the Australian Statistical Geography Standard Remoteness Structure, these hospitals were classified as metropolitan (major cities) or non-metropolitan (inner regional, outer regional, remote or very remote).

RESULTS: Most SABSI were community associated: 66.9% and 75.0% of metropolitan (n = 9,441) and non-metropolitan (n = 2,756) hospital SABSI, respectively. The overall HA-SABSI rate was statistically higher in metropolitan hospitals (1.13 per 10,000 occupied bed days [OBDs]) compared to non-metropolitan hospitals (0.82 per 10,000 OBDs) (p < 0.001). In metropolitan and non-metropolitan hospitals, there was a statistically significant decline in the overall HA-SABSI rate (IRR = 0.96, 95% CI: 0.95-0.97, P < 0.001 and IRR = 0.98, 95% CI: 0.97-1.00, P = 0.044) respectively). In metropolitan and non-metropolitan hospitals, HA-SABSI were frequently associated with central venous (52.8%) and peripheral intravenous catheter (62.2%) use respectively.

CONCLUSION: To reduce risks for SABSI and improve patient outcomes, hospital infection prevention and control programs should be tailored according to local epidemiology. In common geographic locations, networking of hospitals should be considered as a means of strengthening delivery of these programs. This article is protected by copyright. All rights reserved.

PMID:34549859 | DOI:10.1111/imj.15538