Article Figures & Data
Figures
- FIG 1
Rates of infections by S. aureus per 1,000 inpatients from 2003 to 2014 by subtype (A) and major antibiogram type (B). Estimates adjusted for age, sex, Charlson comorbidity index, type of clinical isolate (blood versus nonblood) and onset (community versus hospital). Lines represent model fits, shaded areas are 95% confidence intervals, and data points represent unadjusted rates. Asterisks indicate the trends are significant. The “other” category for antibiogram type was omitted for clarity.
- FIG 2
Mean resistances of S. aureus isolates from 2000 to 2014. Estimates adjusted for age, sex, Charlson comorbidity index, type of clinical isolate (blood versus nonblood), and onset (community versus hospital). Lines represent model fits, shaded areas are 95% confidence intervals, and data points represent unadjusted mean resistances. Asterisks indicate trends are significant.
- FIG 3
Phylogeny of contemporary S. aureus isolates and gain and loss of methicillin resistance at the strain level. (A) Unrooted maximum likelihood phylogeny of 180 S. aureus isolates obtained between 1 January 2016 and 22 July 2016. Select clonal complexes are identified in red circles. (B) Inference of ancestral presence or absence of methicillin resistance in sequence type 5 (CC5) and sequence type 8 (CC8) phylogenies (shown here as dendrograms) estimated using parsimony. Inner rings represent penicillin susceptibility, and outer rings represent methicillin susceptibility. Orange circles represent acquisition of methicillin resistance, and magenta circles represent loss of methicillin resistance. Branch lengths are intended to maximize visual clarity and are not proportional to genetic distance. CC, clonal complex.
Tables
- TABLE 1
Demographic and microbiologic characteristics of patients and S. aureus subtypes
Subtype No. of isolates Mean patient age (yr [SD]) % female patients CCIa (mean [median]) Site of infection (%) % community onset infections Blood Lung SSI Other All S. aureus 45,707 58.8 (18.3) 41 2.8 (2) 16 34 28 22 62 MRSA 22,799 61.5 (18.1) 42 3.0 (2) 16 38 25 22 54 MSSA 18,154 55.6 (18.2) 40 2.4 (2) 17 30 31 22 69 PSSA 4,754 57.8 (18.1) 40 2.6 (2) 16 32 29 23 68 P valueb MRSA vs MSSA <0.0001 0.005 <0.0001 <0.0001 <0.0001 MRSA vs PSSA <0.0001 0.12 <0.0001 <0.0001 <0.0001 MSSA vs PSSA <0.0001 0.87 0.0005 0.0012 0.76 - TABLE 2
Adjusted rates of inpatient infections of S. aureus by subtype and antibiogram type per 1,000 inpatients in 2003 and 2014
Subtype or antibiogram type Rate of infections/1,000 inpatients (% [95% CI])b Annual % change (95% CI) in countsb P value 2003 2014 Subtype All S. aureus 33.4 (23.5–43.3) 21.3 (11.5–31.2) −4.2 (−5.6 to −2.7) <0.0001 MRSA 21.1 (17.0–25.1) 6.3 (2.2–10.4) −10.9 (−12.6 to −9.3) <0.0001 MSSA 11.1 (9.0–13.3) 10.3 (8.2–12.5) −0.6 (−2.1 to 0.9) 0.43 PSSA 1.9 (1.2–2.7) 4.0 (3.2–4.7) 6.1 (4.2 to 8.1) <0.0001 Antibiogram typea PMEL 15.8 (12.6–19.0) 4.9 (1.7–8.1) −12.1 (−13.6 to −10.5) <0.0001 PME 1.0 (0.1–1.9) 1.4 (0.4–2.3) 3.0 (−0.1 to 6.2) 0.06 PE 3.2 (3.0–3.5) 2.8 (2.6–3.1) −1.4 (−3.2 to 0.5) 0.14 P 6.2 (4.8–7.6) 6.0 (4.6–7.4) −0.3 (−2.3 to 1.8) 0.80 Pansusceptible 1.3 (0.8–1.7) 2.3 (1.9–2.8) 5.3 (3.1 to 7.5) <0.0001 Other 3.9 (1.8–6.0) 6.0 (3.9–8.0) 3.3 (0.2 to 6.4) 0.04 ↵a Antibiogram types exclude clindamycin. “Other” category includes all antibiograms not belonging to top 5 most common antibiogram types. PMEL, penicillin-, methicillin-, erythromycin-, and levofloxacin-resistant S. aureus; PME, penicillin-, methicillin-, and erythromycin-resistant S. aureus; PE, penicillin- and erythromycin-resistant S. aureus; P, penicillin-resistant S. aureus.
↵b Percentage estimates adjusted for age, sex, Charlson comorbidity index, type of clinical isolate (blood versus nonblood), and onset (community versus hospital).
- TABLE 3
Adjusted mean antibiotic resistances of S. aureus by subtype in 2000 and 2014
Subtype Mean resistance (no. of antibiotics [95% CI])a Absolute change (no. of antibiotics [95% CI]) P value 2000 2014 All S. aureus 3.2 (3.1–3.2) 2.3 (2.3–2.4) −0.8 (−0.8 to −0.7) <0.0001 MRSA 4.5 (4.5–4.6) 3.7 (3.7–3.8) −0.9 (−1.0 to −0.8) <0.0001 MSSA 1.6 (1.5–1.6) 1.5 (1.5–1.6) 0.0 (−0.1 to 0.1) 0.89 PSSA 0.6 (0.6–0.7) 0.6 (0.5–0.6) −0.1 (−0.1 to 0.0) 0.05 ↵a Estimates adjusted for age, sex, Charlson comorbidity index, type of clinical isolate (blood versus nonblood), and onset (community versus hospital).
Supplemental material
- Supplemental file 1 -
Tables S1 (Characteristics of retrospective and prospective samples by subtype and antibiogram type), S2 (Demographic and microbiologic characteristics of S. aureus antibiogram types), and S3 (Distribution of clonal complex by subtype and antibiogram type); Fig. S1 (Adjusted rates of erythromycin, clindamycin, and levofloxacin resistance in S. aureus), S2 (Adjusted rates of S. aureus by major antibiogram type, excluding or including clindamycin, 2010 to 2014), S3 (Mean resistance in S. aureus, excluding or including clindamycin and comparing blood and nonblood isolates), S4 (Complete phylogeny of S. aureus isolates), S5 (Genetic basis for loss of methicillin resistance in ST5/CC5 and ST8/CC8), and S6 (Antibiotic susceptibility testing protocols for S. aureus, 2000 to 2014); and Supplemental methods (Detailed sample preparation for microfluidics platform and bioinformatic analyses)
PDF, 1.4M
- Supplemental file 1 -
