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Seasonal Variation of Escherichia coli, Staphylococcus aureus, and Streptococcuspneumoniae Bacteremia According to Acquisition and Patient Characteristics: A Population-Based Study

Published online by Cambridge University Press:  04 May 2016

Kim Oren Gradel*
Affiliation:
Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
Stig Lønberg Nielsen
Affiliation:
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
Court Pedersen
Affiliation:
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
Jenny Dahl Knudsen
Affiliation:
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
Christian Østergaard
Affiliation:
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
Magnus Arpi
Affiliation:
Department of Clinical Microbiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
Thøger Gorm Jensen
Affiliation:
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
Hans Jørn Kolmos
Affiliation:
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
Mette Søgaard
Affiliation:
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
Annmarie Touborg Lassen
Affiliation:
Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
Henrik Carl Schønheyder
Affiliation:
Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, AalborgDenmark
*
Address correspondence to Kim Oren Gradel, DVM, PhD, Center for Clinical Epidemiology, OUH Odense University Hospital, Sdr. Boulevard 29, Entrance 101, 4th floor, DK-5000 Odense C, Denmark ([email protected]).

Abstract

OBJECTIVE

Seasonal variation is a characteristic of many infectious diseases, but relatively little is known about determinants thereof. We studied the impact of place of acquisition and patient characteristics on seasonal variation of bacteremia caused by the 3 most common pathogens.

DESIGN

Seasonal variation analysis.

METHODS

In 3 Danish health regions (2.3 million total inhabitants), patients with bacteremia were identified from 2000 through 2011 using information from laboratory information systems. Analyses were confined to Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. Additional data were obtained from the Danish National Hospital Registry for the construction of admission histories and calculation of the Charlson comorbidity index (CCI). Bacteremias were categorized as community acquired, healthcare associated (HCA), and hospital acquired. We defined multiple subgroups by combining the following characteristics: species, acquisition, age group, gender, CCI level, and location of infection. Assuming a sinusoidal model, seasonal variation was assessed by the peak-to-trough (PTT) ratio with a 95% confidence interval (CI).

RESULTS

In total, we included 16,006 E. coli, 6,924 S. aureus, and 4,884 S. pneumoniae bacteremia cases. For E. coli, the seasonal variation was highest for community-acquired cases (PTT ratio, 1.24; 95% CI, 1.17–1.32), was diminished for HCA (PTT ratio, 1.14; 95% CI, 1.04–1.25), and was missing for hospital-acquired cases. No seasonal variation was observed for S. aureus. S. pneumoniae showed high seasonal variation, which did not differ according to acquisition (overall PTT ratio, 3.42; 95% CI, 3.10–3.83).

CONCLUSIONS

Seasonal variation was mainly related to the species although the place of acquisition was important for E. coli.

Infect Control Hosp Epidemiol 2016;37:946–953

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. Gradel KO, Nielsen SL, Pedersen C, Knudsen JD, Østergaard C, Arpi M, Jensen TG, Kolmos HJ, Søgaard M, Lassen AT presented these data in part as Poster P0012, “Seasonal variation in blood stream infection in relation to bacterial agents and acquisition” at the 25th European Congress of Clinical Microbiology and Infectious Diseases, April 25–28, 2015, in Copenhagen, Denmark.

References

REFERENCES

1. Fisman, DN. Seasonality of infectious diseases. Annu Rev Public Health 2007;28:127143.CrossRefGoogle ScholarPubMed
2. Laupland, KB, Church, DL. Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev 2014;27:647664.CrossRefGoogle ScholarPubMed
3. Goto, M, Al-Hasan, MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013;19:501509.CrossRefGoogle Scholar
4. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.CrossRefGoogle ScholarPubMed
5. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791797.CrossRefGoogle ScholarPubMed
6. Alcorn, K, Gerrard, J, Macbeth, D, Steele, M. Seasonal variation in health care-associated bloodstream infection: increase in the incidence of Gram-negative bacteremia in nonhospitalized patients during summer. Am J Infect Control 2013;41:12051208.CrossRefGoogle ScholarPubMed
7. Kim, PE, Musher, DM, Glezen, WP, Rodriguez-Barradas, MC, Nahm, WK, Wright, CE. Association of invasive pneumococcal disease with season, atmospheric conditions, air pollution, and the isolation of respiratory viruses. Clin Infect Dis 1996;22:100106.CrossRefGoogle ScholarPubMed
8. Chazan, B, Colodner, R, Edelstein, H, Raz, R. Seasonal variation in Escherichia coli bloodstream infections in northern Israel. Clin Microbiol Infect 2011;17:851854.CrossRefGoogle ScholarPubMed
9. Kaier, K, Frank, U, Conrad, A, Meyer, E. Seasonal and ascending trends in the incidence of carriage of extended-spectrum ss-lactamase-producing Escherichia coli and Klebsiella species in 2 German hospitals. Infect Control Hosp Epidemiol 2010;31:11541159.Google ScholarPubMed
10. Talbot, TR, Poehling, KA, Hartert, TV, et al. Seasonality of invasive pneumococcal disease: temporal relation to documented influenza and respiratory syncytial viral circulation. Am J Med 2005;118:285291.CrossRefGoogle ScholarPubMed
11. Eber, MR, Shardell, M, Schweizer, ML, Laxminarayan, R, Perencevich, EN. Seasonal and temperature-associated increases in Gram-negative bacterial bloodstream infections among hospitalized patients. PLoS One 2011;6:e25298.CrossRefGoogle ScholarPubMed
12. Baine, WB, Yu, W, Summe, JP. The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991–1998. Application of Medicare claims data. Ann Epidemiol 2001;11:118126.CrossRefGoogle ScholarPubMed
13. Anderson, DJ, Richet, H, Chen, LF, et al. Seasonal variation in Klebsiella pneumoniae bloodstream infection on 4 continents. J Infect Dis 2008;197:752756.CrossRefGoogle ScholarPubMed
14. Dowell, SF, Whitney, CG, Wright, C, Rose, CE Jr., Schuchat, A. Seasonal patterns of invasive pneumococcal disease. Emerg Infect Dis 2003;9:573579.CrossRefGoogle ScholarPubMed
15. Al-Hasan, MN, Lahr, BD, Eckel-Passow, JE, Baddour, LM. Seasonal variation in Escherichia coli bloodstream infection: a population-based study. Clin Microbiol Infect 2009;15:947950.CrossRefGoogle ScholarPubMed
16. Goncalves-Pereira, J, Povoa, PR, Lobo, C, Carneiro, AH. Bloodstream infections as a marker of community-acquired sepsis severity. Results from the Portuguese community-acquired sepsis study (SACiUCI study). Clin Microbiol Infect 2013;19:242248.CrossRefGoogle ScholarPubMed
17. Deeny, SR, van Kleef, E, Bou-Antoun, S, Hope, RJ, Robotham, JV. Seasonal changes in the incidence of Escherichia coli bloodstream infection: variation with region and place of onset. Clin Microbiol Infect 2015;21:924929.CrossRefGoogle ScholarPubMed
18. Gradel, KO, Dethlefsen, C, Schønheyder, HC, et al. Severity of infection and seasonal variation of non-typhoid Salmonella occurrence in humans. Epidemiol Infect 2007;135:9399.CrossRefGoogle ScholarPubMed
19. Gradel, KO, Nielsen, SL, Pedersen, C, et al. No specific time window distinguishes between community-, healthcare-, and hospital-acquired bacteremia, but they are prognostically robust. Infect Control Hosp Epidemiol 2014;35:14741482.CrossRefGoogle ScholarPubMed
20. Gradel, KO, Schønheyder, HC, Arpi, M, Knudsen, JD, Østergaard, C, Søgaard, M. The Danish Collaborative Bacteraemia Network (DACOBAN) database. Clin Epidemiol 2014;6:301308.CrossRefGoogle ScholarPubMed
21. Nielsen, SL, Pedersen, C, Jensen, TG, Gradel, KO, Kolmos, HJ, Lassen, AT. Decreasing incidence rates of bacteremia: a 9-year population-based study. J Infect 2014;69:5159.CrossRefGoogle ScholarPubMed
22. Schmidt, M, Pedersen, L, Sorensen, HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 2014;29:541549.CrossRefGoogle ScholarPubMed
23. Gradel, KO, Jensen, TG, Kolmos, HJ, Pedersen, C, Vinholt, PJ, Lassen, AT. Does C-reactive protein independently predict mortality in adult community-acquired bacteremia patients with known sepsis severity? APMIS 2013;121:835842.CrossRefGoogle ScholarPubMed
24. Gradel, KO, Knudsen, JD, Arpi, M, Østergaard, C, Schønheyder, HC, Søgaard, M. Classification of positive blood cultures: computer algorithms versus physicians’ assessment - development of tools for surveillance of bloodstream infection prognosis using population-based laboratory databases. BMC Med Res Methodol 2012;12:139.CrossRefGoogle ScholarPubMed
25. Trick, WE, Zagorski, BM, Tokars, JI, et al. Computer algorithms to detect bloodstream infections. Emerg Infect Dis 2004;10:16121620.CrossRefGoogle ScholarPubMed
26. Lynge, E, Sandegaard, JL, Rebolj, M. The Danish National Patient Register. Scand J Public Health 2011;39:3033.CrossRefGoogle ScholarPubMed
27. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.CrossRefGoogle ScholarPubMed
28. Schønheyder, HC, Søgaard, M. Existing data sources for clinical epidemiology: The North Denmark Bacteremia Research Database. Clin Epidemiol 2010;2:171178.CrossRefGoogle ScholarPubMed
29. Edwards, JH. The recognition and estimation of cyclic trends. Ann Hum Genet 1961;25:8387.CrossRefGoogle ScholarPubMed
30. Episheet - Spreadsheets for the Analysis of Epidemiologic Data. BWH Department of Medicine Division of Pharmacoepidemiology and Pharmacoeconomics website. http://www.drugepi.org/dope-downloads/#Episheet. Accessed March 9, 2015.Google Scholar
31. Perencevich, EN, McGregor, JC, Shardell, M, et al. Summer peaks in the incidences of Gram-negative bacterial infection among hospitalized patients. Infect Control Hosp Epidemiol 2008;29:11241131.CrossRefGoogle ScholarPubMed
32. Tasher, D, Stein, M, Simoes, EA, Shohat, T, Bromberg, M, Somekh, E. Invasive bacterial infections in relation to influenza outbreaks, 2006–2010. Clin Infect Dis 2011;53:11991207.CrossRefGoogle ScholarPubMed
33. Freeman, JT, Anderson, DJ, Sexton, DJ. Seasonal peaks in Escherichia coli infections: possible explanations and implications. Clin Microbiol Infect 2009;15:951953.CrossRefGoogle ScholarPubMed
34. Richet, H. Seasonality in Gram-negative and healthcare-associated infections. Clin Microbiol Infect 2012;18:934940.CrossRefGoogle ScholarPubMed
35. Jansen, AG, Sanders, EA, van der Ende, A, van Loon, AM, Hoes, AW, Hak, E. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity? Epidemiol Infect 2008;136:14481454.CrossRefGoogle ScholarPubMed
36. Dowell, SF. Seasonal variation in host susceptibility and cycles of certain infectious diseases. Emerg Infect Dis 2001;7:369374.CrossRefGoogle ScholarPubMed
37. Gransden, WR, Eykyn, SJ, Phillips, I, Rowe, B. Bacteremia due to Escherichia coli : a study of 861 cases. Rev Infect Dis 1990;12:10081018.CrossRefGoogle Scholar
38. Olesen, B, Kolmos, HJ, Ørskov, F, Ørskov, I, Gottschau, A. Bacteraemia due to Escherichia coli in a Danish university hospital, 1986–1990. Scand J Infect Dis 1995;27:253257.CrossRefGoogle Scholar
39. Kennedy, KJ, Roberts, JL, Collignon, PJ. Escherichia coli bacteraemia in Canberra: incidence and clinical features. Med J Aust 2008;188:209213.CrossRefGoogle ScholarPubMed
40. Rossignol, L, Pelat, C, Lambert, B, Flahault, A, Chartier-Kastler, E, Hanslik, T. A method to assess seasonality of urinary tract infections based on medication sales and Google trends. PLoS One 2013;8:e76020.CrossRefGoogle ScholarPubMed
41. Henderson, KL, Muller-Pebody, B, Johnson, AP, Wade, A, Sharland, M, Gilbert, R. Community-acquired, healthcare-associated and hospital-acquired bloodstream infection definitions in children: a systematic review demonstrating inconsistent criteria. J Hosp Infect 2013;85:94105.CrossRefGoogle ScholarPubMed