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Severe Staphylococcus Aureus Page 149
Acute Communicable Disease Control 2015 Annual Morbidity Report
SEVERE STAPHYLOCOCCUS AUREUS INFECTION IN PREVIOUSLY HEALTHY PERSONS
aCases per 100,000 population bSee Yearly Summary Reports of Selected General Communicable Diseases in California at: https://www.cdph.ca.gov/data/statistics/Documents/YearlySummaryReportsofSelectedGeneralCommDiseasesinCA2011-2015.pdf cNot notifiable DESCRIPTION Staphylococcus aureus (S. aureus) is bacteria that can cause a number of diseases as a result of infection of various tissues of the body. S. aureus-related illness can range from mild and requiring no treatment to severe and potentially fatal. It is a common cause of skin infections such as boils, abscesses, and cellulitis. It can also cause invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection, and osteomyelitis. Infection can result in severe illness including bacteremia, sepsis, pneumonia, empyema, and necrotizing pneumonia. Certain groups of people are at greater risk including people with chronic conditions such as diabetes, cancer, vascular disease, and lung disease. Those who are intravenous drug users, with skin injuries or disorders, with intravenous catheters, with surgical incisions, and with weakened immune systems due to disease or to immune-suppressing medications have an increased risk of developing S. aureus infections.
In February 2008, in response to the significant public health burden and potential severity of community-associated S. aureus infections, the CDPH added severe cases of S. aureus infections including methicillin-resistant S. aureus (MRSA) to the state list of reportable diseases and conditions. This is not a nationally notifiable disease. For surveillance purposes, a case of community-associated severe S. aureus infection is defined as a laboratory-confirmed S. aureus infection in a person resulting in admission to an intensive care unit (ICU). Additionally, this definition includes laboratory-confirmed infections in deaths who had not been hospitalized or had surgery, dialysis, or residency in a long-term care facility in the year prior to illness. Lastly, this definition includes laboratory-confirmed infections in those who did not have an indwelling catheter or percutaneous medical device at the onset of illness. If any of these conditions were present, the case would be considered healthcare-associated. S. aureus is one of the most common bacterial causes of skin infections that result in a visit to a doctor or hospital. However, most of these infections do not result in ICU admission or death. Therefore, the data presented in this report underestimate all disease caused by this organism in LAC. 2015 TRENDS AND HIGHLIGHTS Cases >65 years old had the highest rate (0.3
per 100,000) in 2015. Blacks, Hispanics, and Whites had the same
rate (0.1 per 100,000) (Figure 2) while 22.2% of cases had no designated race/ethnicity.
The male to female ratio in 2015 was 2:1. The incidence rate was highest in SPA 4 (0.2
per 100,000) (Figure 3). Cases were distributed throughout the year,
peak months being January, February, and August (Figure 4).
Nearly one-fourth (n=2, 22.2%) of the reported cases were MRSA infections (Figure 5).
The most frequently reported risk factors were alcohol abuse, diabetes, obesity, and intravenous drug use (Table 1).
CRUDE DATA
Number of Cases 9
Annual Incidence
LA Countya 0.09
Californiab 0.20
United Statesc N/A
Age at Diagnosis
Mean 57
Median 58
Range 34–78 years
Severe Staphylococcus Aureus Page 150
Acute Communicable Disease Control 2015 Annual Morbidity Report
Pneumonia, septic shock, septic emboli, and endocarditis were among the common presentations for S. aureus infections (Table 2).
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Acute Communicable Disease Control 2015 Annual Morbidity Report
Reported Severe Staphylococcus Aureus Cases and Rates* per 100,000 by Age Group, Race/Ethnicity, and SPA LAC, 2011-2015
2011 (N=44) 2012 (N=24) 2013 (N=26) 2014 (N=17) 2015 (N=9) No. (%) Rate/
100,000 No. (%) Rate/100,000 No. (%) Rate/
100,000 No. (%) Rate/100,000 No. (%) Rate/
100,000
Age Group
<1 0 0.0 0.0 1 4.2 0.8 1 3.8 0.8 0 0.0 0.0 0 0.0 0.0 1-4 0 0.0 0.0 0 0.0 0.0 0 0.0 0.0 0 0.0 0.0 0 0.0 0.0 5-14 2 4.5 0.2 1 4.2 0.1 0 0.0 0.0 0 0.0 0.0 0 0.0 0.0 15-34 6 13.6 0.2 3 12.5 0.1 7 26.9 0.2 3 17.6 0.1 1 11.1 0.0 35-44 6 13.6 0.4 2 8.3 0.2 2 7.7 0.2 3 17.6 0.2 1 11.1 0.1 45-54 9 20.5 0.7 3 12.5 0.2 6 23.1 0.5 3 17.6 0.2 1 11.1 0.1 55-64 8 18.2 0.8 5 20.8 0.5 5 19.2 0.5 3 17.6 0.3 2 22.2 0.2 65+ 13 29.5 1.2 9 37.5 0.8 5 19.2 0.5 5 29.4 0.4 4 44.4 0.3 Unknown 0 - - 0 - - 0 - - 0 - - 0 - -
Race/Ethnicity Asian 7 15.9 0.5 4 16.7 0.3 3 11.5 0.2 4 23.5 0.3 0 0.0 0.0 Black 3 6.8 0.4 4 16.7 0.5 5 19.2 0.6 2 11.8 0.3 1 11.1 0.1 Hispanic 17 38.6 0.4 4 16.7 0.1 10 38.5 0.2 3 17.6 0.1 3 33.3 0.1 White 15 34.1 0.5 10 41.7 0.4 8 30.8 0.3 0 0.0 0.0 3 33.3 0.1 Other 1 2.3 - 1 4.2 - 0 - - 1 5.9 - 0 - - Unknown 1 2.3 - 1 4.2 - 0 - - 7 41.2 - 2 22.2 -
SPA 1 0 0.0 0.0 2 8.3 0.5 1 3.8 0.3 0 0.0 0.0 0 0.0 0.0 2 12 27.3 0.5 1 4.2 0.0 6 23.1 0.3 2 11.8 0.1 1 11.1 0.0 3 7 15.9 0.4 8 33.3 0.5 1 3.8 0.1 6 35.3 0.4 2 22.2 0.1 4 2 4.5 0.2 2 8.3 0.2 4 15.4 0.4 5 29.4 0.4 2 22.2 0.2 5 5 11.4 0.8 1 4.2 0.2 2 7.7 0.3 1 5.9 0.2 0 0.0 0.0 6 11 25.0 1.0 5 20.8 0.5 5 19.2 0.5 1 5.9 0.1 1 11.1 0.1 7 5 11.4 0.4 4 16.7 0.3 3 11.5 0.2 0 0.0 0.0 0 0.0 0.0 8 1 2.3 0.1 0 0.0 0.0 2 7.7 0.2 2 11.8 0.2 1 11.1 0.1 Unknown 1 2.3 - 1 4.2 - 2 7.7 - 0 - - 2 22.2 -
*Rates calculated based on less than 19 cases or events are considered unreliable.
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Acute Communicable Disease Control 2015 Annual Morbidity Report
*Rates calculated based on less than 19 cases or events are considered unreliable.
0
0.2
0.4
0.6
0.8
1
1.2
<1 1-4 5-14 15-34 35-44 45-54 55-64 65+
Cas
es p
er 1
00,0
00
Age Group in Years
Figure 1. Incidence Rates* of Severe S. aureus Infectionby Age Group, LAC, 2014-2015
2014
2015
0
0.1
0.2
0.3
0.4
0.5
0.6
White Black Asian Hispanic
Cas
es p
er 1
00,0
00
Race/Ethnicity
Figure 2. Severe S. aureus Infection Incidence Rates*by Race/Ethnicity, LAC, 2014-2015
2014
2015
0
0.25
0.5
0.75
1
1.25
1 2 3 4 5 6 7 8
Cas
es p
er 1
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00
SPA
Figure 3. Incidence Rates* of Severe S. aureus Infection by SPALAC, 2014-2015
2014
2015
0
1
2
3
4
5
6
7
1 2 3 4 5 6 7 8 9 10 11 12
Nu
mb
er o
f C
ases
Month
Figure 4. Reported Severe S. aureus Cases by Month of OnsetLAC, 2014-2015
2014
2015
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Acute Communicable Disease Control 2015 Annual Morbidity Report
Table 1. Severe S. aureus Medical Conditions by Date of Onset, 2014-2015
2014 N = 17
2015 N = 9
N %* N %*
Alcohol Abuse 1 6 3 33 Diabetes 6 35 2 22 Obesity 0 0 2 22 IVDU 0 0 2 22 Chronic Dermatitis 1 6 1 11 Current Smoker 3 18 1 11 Emphysema 3 18 1 11 HIV/AIDS 2 12 1 11 None 2 12 1 11 Unknown 0 0 1 11 Chronic Renal 0 0 1 11 Malignancy-Hem 0 0 1 11 Other 5 29 0 0 Intravenous Drug Use 3 18 0 0 Malignancy-Solid 2 12 0 0 Liver Disease 0 0 0 0
*Overlapping risk factors will total over 100%.
Table 2. Frequency and Percentage of Severe S. aureus Clinical Syndromes, LAC, 2015 (N=9)
Syndrome Number Percent*
Pneumonia 2 22.2
Bacteremia (without focus) 1 11.1
Septic Shock 2 22.2
Endocarditis 2 22.2
Septic emboli 2 22.2
Other 1 11.1
Meningitis 1 11.1
*Overlapping syndromes will total over 100%.
Figure 5. Percent Cases of Severe S. aureus Infection by Methicillin-Resistance Type, LAC, 2015 (N=9)
MSSA**
78%
MRSA*22%
*MRSA=Methicillin Resistance Staphylococcus aureus **MSSA=Methicillin Sensitive Staphylococcus aureus
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Acute Communicable Disease Control 2015 Annual Morbidity Report
Acute Communicable Disease Control2014 Annual Morbidity Report
STAPHYLOCOCCUS AUREUS, SEVERE INFECTIONSIN PREVIOUSLY HEALTHY PERSONS
aCases per 100,000 populationbSee Yearly Summary Reports of Selected General Communicable Diseases in California at: http://www.cdph.ca.gov/data/statistics/Pages/CDdata.aspx(2013 data)cNot notifiable.
DESCRIPTION
Staphylococcus aureus (S. aureus) is bacteria that can cause a number of infections and syndromes as a result of its ability to infectvarious tissues of the body and to produce toxins.S. aureus-related illness can range from mild and requiring no treatment to severe and potentially fatal. It is a common cause of skin infections,causing boils, abscesses, and cellulitis. It can also cause invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection,and osteomyelitis. Infection can result in severe illness, including bacteremia, sepsis, pneumonia, empyema, necrotizing pneumonia, and toxic shock syndrome.
Certain groups of people are at greater risk of getting S. aureus infections. This includes: injection drug users, those with skin injuries or disorders, those with intravenous catheters orsurgical incisions, and those with a weakened immune system due either to disease or a result of immune suppressing medications. Risk also is increased among people with chronic conditions such as diabetes, cancer, vascular disease, and lung disease.
In February 2008 in response to the significant public health burden and potential severity of community-associated S. aureus infections, the
California Department of Public Health addedsevere cases of S. aureus infections, including methicillin-resistant S. aureus (MRSA), to the state list of reportable diseases and conditions.This is not a nationally notifiable disease.
For surveillance purposes, a case of community-associated severe S. aureus infection is defined as a laboratory-confirmed S. aureus infection in a person resulting in admission to an intensive care unit (ICU) or a person who died and who had not been hospitalized or had surgery, dialysis, or residency in a long-term care facility in the year prior to illness, and did not have an indwelling catheter or percutaneous medical device at the onset of illness. If any of these conditions were present, the case would be considered healthcare-associated.
Because the large majority of S. aureus infectionsnot result in an ICU admission or death, the data presented in this report substantially underestimates all disease caused by this organism in LAC.
2014 TRENDS AND HIGHLIGHTS
Because of the low number of reported cases each year, interpreting trends and associations is difficult as rates may be significantly affected by the occurrence of a small number of cases. For example, whereas in 2014 there were no cases among infants, in 2010, 2012 and 2013, a single infant case resulted in the incidence rate among those <1 year old being higher than for any other age group. In 2014, cases aged 65 years and older had the highest rate (0.4per 100,000) and each year, after infancy rates have increased with age (Figure 1).Blacks and Asians had the highest rate (0.6per 100,000) (Figure 2).The male to female ratio in 2014 was 1:0.6.The incidence rate was highest in SPAs 3and 4 (0.4 per 100,000) (Figure 3).Cases were distributed throughout the year with the peak months being December, February and August (Figure 4).Four (24%) of the reported S. aureus infections were resistant to methicillin (Figure 5).The most frequently reported risk factors were diabetes and being a current smoker(Table 1). Intravenous drug use was present
CRUDE DATA
Number of Cases 17
Annual Incidence
LA Countya 0.18
Californiab 0.30
United Statesc N/A
Age at Diagnosis
Mean 55
Median 50
Range 23–97 years
Staphylococcus Aureus, Severe InfectionsPage 189
Acute Communicable Disease Control2014 Annual Morbidity Report
for about 20% of cases in each of 2013 and 2014.Reported severe S. aureus cases presented most often with pneumonia, bacteremia,and/or the toxic shock syndrome (Table 2).
Thirty percent of cases were reported from the LAC coroner and >50% of cases came from two reporting sources. Thus, underreporting of severe S. aureus infections in LAC is likely.
Staphylococcus Aureus, Severe InfectionsPage 190
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Severe Staphylococcus Aureus Page 185
Acute Communicable Disease Control2013 Annual Morbidity Report
SEVERE STAPHYLOCOCCUS AUREUS INFECTION IN PREVIOUSLY HEALTHY PERSONS
aCases per 100,000 population
bSee Yearly Summary Reports of Selected General Communicable Diseases in California at: http://www.cdph.ca.gov/data/statistics/Pages/CD-YearlyTables.aspx (2011 data) cNot notifiable.
DESCRIPTION
Staphylococcus aureus (S. aureus) is bacteria that can cause a number of diseases as a result of infection of various tissues of the body. S. aureus-related illness can range from mild and requiring no treatment to severe and potentially fatal. It is a common cause of skin infections, causing boils, abscesses, and cellulitis. It can also cause invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection, and osteomyelitis. Infection can result in severe illness, including bacteremia, sepsis, pneumonia, empyema and necrotizing pneumonia.
Certain groups of people are at greater risk, including people with chronic conditions such as diabetes, cancer, vascular disease, and lung disease. Injecting drug users, those with skin injuries or disorders, intravenous catheters, surgical incisions, and those with a weakened immune system due either to disease or a result of immune suppressing medications all have an increased risk of developing S. aureusinfections.
For surveillance purposes, a case of community-associated severe S. aureus infection is defined as a laboratory-confirmed S. aureus infection in a person resulting in admission to an intensive
care unit (ICU) or death who had not been hospitalized or had surgery, dialysis, or residency in a long-term care facility in the year prior to illness, and did not have an indwelling catheter or percutaneous medical device at the onset of illness. If any of these conditions were present, the case would be considered healthcare-associated.
S. aureus is one of the most common bacterial causes of skin infections that result in a visit to adoctor or the hospital. However, most of these infections do not result in ICU admission or death. Therefore, the data presented in this report underestimate all disease caused by this organism in Los Angeles County (LAC).
2013 TRENDS AND HIGHLIGHTS
2013 cases aged <1 year had the highestrate (0.8 per 100,000) which was similar to2012 (Figure 1).As in the previous year, blacks had thehighest rate (0.6 per 100,000) (Figure 2).The male:female ratio in 2013 was 1:0.4.Similar to previous years, the incidence ratewas highest in SPA 6 (0.5 per 100,000)(Figure 3).Cases were distributed throughout the yearwith the peak months being January to May(Figure 4).Seven (27%) of the reported cases were S.aureus infections resistant to methicillin(Figure 5).The most frequently reported risk factorswere liver disease, diabetes, currentsmoker, and intravenous drug user (Table1).Severe S. aureus cases presented mostoften with bacteremia and pneumonia (Table2).Fifty-eight percent of cases were reportedfrom two reporting sources in LAC. Thus,underreporting of severe S. aureusinfections in LAC is likely.
CRUDE DATA
Number of Cases 26
Annual Incidence
LA Countya 0.28
Californiab 0.45
United Statesc N/A
Age at Diagnosis
Mean 48
Median 49
Range 0-87 years
Sev
ere
Sta
phyl
oco
ccus
Aur
eus
Pag
e 18
6
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2013
Ann
ual M
orbi
dity
Rep
ort
Rep
ort
ed S
ever
e S
tap
hyl
oco
ccu
s A
ure
us
Cas
es a
nd
Rat
es*
per
100
,000
by
Ag
e G
rou
p,
Rac
e/E
thn
icit
y, a
nd
SP
A
Lo
s A
ng
eles
Co
un
ty,
2009
-201
3
20
09
(N
=2
7)
20
10
(N
=2
8)
20
11
(N
=4
4)
20
12
(N
=2
4)
20
13
(N
=2
6)
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
Ag
e G
rou
p
<1
00.
00.
01
4.0
0.8
00.
00.
01
4.2
0.8
13.
80.
81-
41
3.7
0.2
00.
00
00.
00.
00
00
00
05-
142
7.4
0.1
310
.70.
22
4.5
0.2
14.
20.
1 0
00
15-3
45
18.5
0.2
621
.40.
26
13.6
0.2
312
.50.
1 7
26.9
0.2
35-4
43
11.1
0.2
310
.70.
26
13.6
0.5
28.
30.
22
7.7
0.2
45-5
46
22.2
0.5
725
.00.
59
20.4
0.7
312
.50.
2 6
23.0
0.5
55-6
44
14.8
0.4
310
.70.
38
18.2
0.8
520
.80.
5 5
19.2
0.5
65+
622
.20.
65
17.9
0.5
1329
.51.
29
37.5
0.8
519
.20.
5U
nkno
wn
00.
00
0.0
00.
00
0R
ace/
Eth
nic
ity
Asi
an
13.
70.
14
14.2
0.3
715
.90.
54
16.7
0.3
311
.50.
2Bla
ck
311
.10.
44
14.2
0.5
36.
80.
44
16.7
0.5
519
.20.
6H
ispa
nic
1244
.40.
37
25.0
0.2
1738
.60.
44
16.7
0.1
1038
.50.
2W
hite
11
40.7
0.4
1346
.40.
515
34.1
0.6
1041
.70.
48
30.8
0.3
Oth
er
00.
00.
00
0.0
0.0
12.
31
4.2
0U
nkno
wn
00.
00
0.0
12.
31
4.2
SP
A 1
311
.10.
81
4.0
0.
3 0
0.0
0.0
28.
30.
5 1
3.8
0.3
22
7.4
0.1
621
.4 0.
3 12
27.3
0.6
14.
20.
06
23.0
0.3
34
14.8
0.2
621
.4 0.
4 7
15.9
0.4
833
.30.
5 1
3.8
0.1
43
11.1
0.3
414
.20.
42
4.5
0.2
28.
30.
2 4
15.4
0.4
51
3.7
0.2
27.
10.
35
11.4
0.8
14.
20.
2 2
7.7
0.3
69
33.3
0.9
27.
10.
211
25.0
1.1
520
.80.
55
19.2
0.5
72
7.4
0.1
414
.20.
35
11.4
0.4
416
.70.
3 3
11.5
0.2
82
7.4
0.1
2
7.1
0.2
1
2.3
0.1
0
00
2
7.
70.
2
Unk
now
n 1
3.7
1
4.0
1
2.3
1
4.2
2
7.7
*Rat
es c
alcu
late
d ba
sed
on le
ss t
han
19 c
ases
or
even
ts a
re c
onsi
dere
d un
relia
ble.
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
Pag
e 18
7
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2013
Ann
ual M
orbi
dity
Rep
ort
0
0.2
0.4
0.6
0.81
1.2
<1
1-4
5-14
15-3
435
-44
45-5
455
-64
65+
Cases per 100,000
Ag
e G
rou
p in
Yea
rs
Fig
ure
1.
Inci
den
ce R
ates
* o
f S
eve
re S
. au
reu
sIn
fect
ion
by
Ag
e G
rou
p L
AC
, 2
01
1-2
01
3
2011
2012
2013
0
0.2
5
0.5
0.7
51
1.2
5
12
34
56
78
Cases per 100,000
SP
A
Fig
ure
3.
Inci
den
ce R
ates
* o
f S
eve
re S
. au
reu
sIn
fect
ion
by
SP
AL
AC
, 2
01
1-2
01
3
2011
2012
2013
0
0.1
0.2
0.3
0.4
0.5
0.6
Whi
teB
lack
Asi
anH
ispa
nic
Cases per 100,000
Rac
e/E
thn
icit
y
Fig
ure
2.
Sev
ere
S.
aure
us
Infe
ctio
n In
cid
ence
Rat
es*
by
Rac
e/E
thn
icit
y L
AC
, 20
11-2
013
2011
2012
2013
01234567
12
34
56
78
910
1112
Number of Cases
Mo
nth
Fig
ure
4.
Rep
ort
ed S
eve
re S
. au
reu
sC
ases
by
Mo
nth
of
On
set
LA
C,
2012
-201
3
201
2
201
3
*Rat
es c
alcu
late
d ba
sed
on le
ss t
han
19 c
ases
or
even
ts a
re c
onsi
dere
d un
relia
ble
Sev
ere
Sta
phyl
oco
ccus
Aur
eus
Pag
e 18
8
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2013
Ann
ual M
orbi
dity
Rep
ort
Tab
le 2
.F
req
uen
cy
and
Per
cen
tag
e o
f S
eve
reS
. au
reu
sC
lin
ical
Syn
dro
mes
, L
AC
, 20
13
Syn
drom
eN
umbe
rP
erce
nt*
Ba
cte
rem
ia (
with
ou
t fo
cus)
19
73
Pn
eu
mo
nia
72
7
En
do
card
itis
41
5
Ski
n In
fect
ion
41
5
Wou
nd
Infe
ctio
n3
12
Se
ptic
em
bo
li3
12
Me
nin
giti
s1
4
Sep
tic a
rthr
itis
14
To
xic
Sh
ock
Syn
dro
me
14
Oth
er7
27
*Ove
rlapp
ing
synd
rom
es w
ill to
tal o
ver
100%
.
Tab
le 1
.S
eve
reS
. au
reu
sM
ed
ical
Co
nd
itio
ns
by
Da
te o
f O
ns
et,
201
2-2
013
20
12
N =
24
20
13
N =
26
N(%
)*N
(%)*
Live
r D
isea
se2(
8)8
(31
)D
iabe
tes
4(17
)7
(27
)
Cur
rent
Sm
oker
5(21
)6
(23
)
Intr
aven
ous
Dru
g U
se4(
17)
5(1
9)
Alc
oho
l Abu
se3(
13)
3(1
2)
Hea
rt F
ailu
re/C
HF
2(8)
3(1
2)
Em
ph
ysem
a3(
13)
2(8)
HIV
/AID
S1(
4)2(
8)
Ch
ron
ic R
en
al I
nsu
ffici
enc
y0(
0)2(
8)
Ma
lign
an
cy-S
olid
2(
8)1(
4)
Ma
ligna
ncy-
Hem
0(0)
1(4)
Ch
ron
ic D
erm
atiti
s2(
8)0
Ast
hm
a2(
8)0
Ecz
em
a3(
13)
0
Oth
er1
0(4
1)
8(3
1)
No
ne
4(17
)7
(27
)
*Ove
rlapp
ing
risk
fact
ors
will
tota
l ove
r 10
0%.
MS
SA
**
65%
MR
SA
*27
%
Unk
now
n 8%
*MR
SA
=M
ethi
cilli
n R
esis
tanc
e S
taph
yloc
occu
s au
reus
**M
SS
A=
Met
hici
llin
Sen
sitiv
e S
taph
yloc
occu
s au
reus
Fig
ure
5.
Per
cen
t C
ases
of
Sev
ere
S.
aure
us
Infe
ctio
nb
y M
eth
icil
lin
-Res
ista
nce
Typ
e
LA
C, 2
013
(N=
26)
Severe Staphylococcus Aureus Page 185
Acute Communicable Disease Control2012 Annual Morbidity Report
�������STAPHYLOCOCCUS AUREUS������������� ������������������ �������
aCases per 100,000 population bSee Yearly Summary Reports of Selected General Communicable Diseases in California at: http://www.cdph.ca.gov/data/statistics/Pages/CD-YearlyTables.aspx cNot notifiable. ������ ������Staphylococcus aureus (S. aureus) is bacteria that can cause a number of diseases as a result of infection of various tissues of the body. S. aureus-related illness can range from mild and requiring no treatment to severe and potentially fatal. It is a common cause of skin infections, causing boils, abscesses, and cellulitis. It can also cause invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection, and osteomyelitis. Infection can result in severe illness, including bacteremia, sepsis, pneumonia, empyema and necrotizing pneumonia.
Certain groups of people are at greater risk, including people with chronic conditions such as diabetes, cancer, vascular disease, and lung disease. Injecting drug users, those with skin injuries or disorders, intravenous catheters, surgical incisions, and those with a weakened immune system due either to disease or a result of immune suppressing medications all have an increased risk of developing S. aureusinfections.
In February 2008 in response to the significant public health burden and potential severity of community-associated S. aureus infections, the
California Department of Public Health added severe cases of S. aureus infections, including methicillin-resistant S. aureus (MRSA), to the state list of reportable diseases and conditions.This is not a nationally notifiable disease.
For surveillance purposes, a case of community-associated severe S. aureus infection is defined as a laboratory-confirmed S. aureus infection in a person resulting in admission to an intensive care unit (ICU) or death who had not been hospitalized or had surgery, dialysis, or residency in a long-term care facility in the year prior to illness, and did not have an indwelling catheter or percutaneous medical device at the onset of illness. If any of these conditions were present, the case would be considered healthcare-associated.
S. aureus is one of the most common bacterial causes of skin infections that result in a visit to adoctor or the hospital. However, most of these infections do not result in ICU admission or death. Therefore, the data presented in this report underestimate all disease caused by this organism in Los Angeles County (LAC).������������������������������ Cases >65 years of age and cases aged <1
year had the highest rate (0.8 per 100,000) (Figure 1).
� The incidence rate of Hispanics in 2012 (0.1 per 100,000) decreased four-fold compared to 2011 (0.4 per 100,000) (Figure 2).
� The male:female ratio was 1:1. � Incidence rates decreased in four SPAs in
2012 compared with 2011, and increased in two SPAs. In 2012, the incidence rate was highest in SPAs 1, 3, and 6 (0.5 per 100,000). (Figure 3).
� Seven (29%) of the reported cases were S. aureus infections resistant to methicillin (Figure 5).
� The most frequently reported risk factors were being a current smoker, diabetic, and intravenous drug user (Table 1).
� Severe S. aureus cases presented most often with bacteremia and pneumonia (Table 2).
� Forty-two percent of cases were reported from 2 reporting sources in LAC. Thus, underreporting of severe S. aureusinfections in LAC is likely.
���������
Number of Cases 24Annual Incidence
LA Countya 0.26Californiab --United Statesc N/A
Age at DiagnosisMean 56Median 58Range 0-98 years
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
Pag
e 18
6
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2012
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ual M
orbi
dity
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ort
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518
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0.5
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0.2
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44
16.0
0.4
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10.7
0.3
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.20.
85
20.8
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.00.
86
22.2
0.6
517
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513
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00
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00
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ace/
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nic
ity
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te13
52.0
0.4
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46.4
0.5
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610
41.7
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00
0.0
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31
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00
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00.
30
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52
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22
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03
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54
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13
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29
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ort
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47
Severe Staphylococcus Aureus
Page 181
Acute Communicable Disease Control 2011 Annual Morbidity Report
SEVERE STAPHYLOCOCCUS AUREUS INFECTION IN PREVIOUSLY HEALTHY PERSONS
aCases per 100,000 population bSee Yearly Summary Reports of Selected General Communicable Diseases in California at: http://www.cdph.ca.gov/data/statistics/Pages/CD-YearlyTables.aspx cNot notifiable.
DESCRIPTION Staphylococcus aureus is a well known bacterial cause of skin infections, causing boils, abscesses, and cellulitis. Infection can result in severe illness, including invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection like pyomyositis and osteomyelitis, severe pneumonia, empyema, necrotizing pneumonia, disseminated infections with septic emboli, bacteremia, sepsis syndrome, and death. For surveillance purposes, severe S. aureus infection in a previously healthy person is defined as isolation of S. aureus from either a sterile or non-sterile site in a patient that has died or has been admitted to the hospital intensive care unit (ICU) as a result of their infection with S. aureus. In addition, the patient must be previously healthy (i.e., no hospitalizations, surgery, dialysis, residence in long-term care, or percutaneous device/indwelling catheter within the past year). S.aureus is one of the most common bacterial causes of skin infections that result in a visit to a doctor or the hospital. However, most of these infections do not result in ICU admission or death. Therefore, the data presented in this report underestimate all disease caused by this organism in Los Angeles County (LAC). 2011 TRENDS AND HIGHLIGHTS
Cases in the 65+ age group had the highest rate (1.2 per 100,000) followed by cases aged 55-64 years (0.8 per 100,000), there were no cases in the <1 and 1-4 year age groups for 2011 (Figure 1).
The incidence rate of Hispanics in 2011 (0.4 per 100,000) increased four-fold compared to last year (0.1 per 100,000) (Figure 2).
For 2011, incidence rates increased in five of eight SPAs compared with 2010, the highest incidence rate was in SPA 6 (1.0 per 100,000). (Figure 3).
The percentage of S. aureus infections resistant to methicillin was 36% (Figure 5). Diabetes and being a current smoker were reported more than any other risk factors (Table 1). Severe S. aureus cases presented most often with bacteremia and pneumonia (Table 2). Thirty-two percent of cases were reported by just one hospital in LAC. Thus, underreporting of severe
S. aureus infections in LAC is likely.
CRUDE DATA
Number of Cases 44 Annual Incidence
LA Countya 0.45 Californiab -- United Statesc N/A
Age at Diagnosis Mean 53 Median 51 Range 12-96 years
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
Pag
e 18
2
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2011
Ann
ual M
orbi
dity
Rep
ort
Rep
ort
ed S
ever
e S
tap
hyl
oco
ccu
s A
ure
us
Cas
es a
nd
Rat
es*
per
100
,000
by
Ag
e G
rou
p,
Rac
e/E
thn
icit
y, a
nd
SP
A
Lo
s A
ng
eles
Co
un
ty,
2008
-201
1
2
00
7
20
08
(N
=2
5)
20
09
(N
=2
7)
20
10
(N
=2
8)
20
11
(N
=4
4)
N
o.
(%)
Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
Ag
e G
rou
p
<1
N/A
N
/A
N/A
1
4.0
0.7
0 0.
0 0.
0 1
4.0
0.7
0 0.
0 0.
0 1-
4 N
/A
N/A
N
/A
0 0.
0 0.
0 1
3.7
0.2
0 0.
0 0
0 0.
0 0.
0 5-
14
N/A
N
/A
N/A
2
8.0
0.1
2 7.
4 0.
1 3
10.7
0.
2 2
4.5
0.2
15-3
4 N
/A
N/A
N
/A
1 4.
0 0.
0 5
18.5
0.
2 6
21.4
0.
2 6
13.6
0.
2 35
-44
N/A
N
/A
N/A
2
8.0
0.1
3 11
.1
0.1
3 10
.7
0.2
6 13
.6
0.4
45-5
4 N
/A
N/A
N
/A
7 28
.0
0.5
6 22
.2
0.4
7 25
.0
0.5
9 20
.4
0.7
55-6
4 N
/A
N/A
N
/A
4 16
.0
0.4
4 14
.8
0.4
3 10
.7
0.3
8 18
.2
0.8
65+
N
/A
N/A
N
/A
8 32
.0
0.8
6 22
.2
0.6
5 17
.9
0.5
13
29.5
1.
2 U
nkno
wn
N/A
N
/A
N/A
0
0.0
0
0.0
0
0.0
0
0.0
R
ace/
Eth
nic
ity
Asi
an
N/A
N
/A
N/A
3
12.0
0.
2 1
3.7
0.1
4 14
.2
0.3
7 15
.9
0.5
Bla
ck
N/A
N
/A
N/A
4
16.0
0.
5 3
11.1
0.
4 4
14.2
0.
5 3
6.8
0.4
His
pani
c N
/A
N/A
N
/A
5 20
.0
0.1
12
44.4
0.
3 7
25.0
0.
1 17
38
.6
0.4
Whi
te
N/A
N
/A
N/A
13
52
.0
0.4
11
40.7
0.
4 13
46
.4
0.5
15
34.1
0.
5 O
ther
N
/A
N/A
N
/A
0 0.
0 0.
0 0
0.0
0.0
0 0.
0 0.
0 1
2.3
U
nkno
wn
N/A
N
/A
N/A
0
0.0
0
0.0
0
0.0
1
2.3
S
PA
1 N
/A
N/A
N
/A
2 8.
0 0.
5 3
11.1
0.
8 1
4.0
0.
3 0
0.0
0.0
2 N
/A
N/A
N
/A
5 20
.0
0.2
2 7.
4 0.
1 6
21.4
0.
3 12
27
.3
0.5
3 N
/A
N/A
N
/A
8 32
.0
0.5
4 14
.8
0.3
6 21
.4
0.
3 7
15.9
0.
4 4
N/A
N
/A
N/A
1
4.0
0.1
3 11
.1
0.2
4 14
.2
0.3
2 4.
5 0.
2 5
N/A
N
/A
N/A
3
12.0
0.
5 1
3.7
0.2
2 7.
1 0.
3 5
11.4
0.
8 6
N/A
N
/A
N/A
2
8.0
0.2
9 33
.3
0.9
2 7.
1 0.
2
11
25.0
1.
0 7
N/A
N
/A
N/A
1
4.0
0.1
2 7.
4 0.
1 4
14.2
0.
3 5
11.4
0.
4 8
N/A
N
/A
N/A
3
12
.0
0.3
2 7.
4 0.
2 2
7.1
0.2
1
2.3
0.1
Unk
now
n N
/A
N/A
N
/A
0.
0
1
1
1
2.3
*Rat
es c
alcu
late
d ba
sed
on le
ss t
han
19 c
ases
or
even
ts a
re c
onsi
dere
d un
relia
ble.
S
ever
e S
taph
yloc
occu
s A
ureu
s P
age
183
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2011
Ann
ual M
orbi
dity
Rep
ort
Fig
ure
1.
Inc
ide
nc
e R
ate
s*
of
Se
vere
S. a
ure
us
Infe
cti
on
by
Ag
e G
rou
p L
AC
, 20
10
-20
11
0
0.250.5
0.751
1.25
<11-
45-
1415
-34
35-4
445
-54
55-6
465
+
Ag
e G
rou
p i
n Y
ears
Cases per 100,000
2010
2011
Fig
ure
3.
In
cid
ence
Rat
es*
of
Sev
ere
S.
aure
us
Infe
ctio
n b
y S
PA
LA
C, 2
010-
2011
0
0.250.5
0.751
12
34
56
78
SP
A
Cases per 100,000
20
10
20
11
Fig
ure
2.
Sev
ere
S. a
ure
us
Infe
ctio
n In
cid
ence
Rat
es*
by
Rac
e/E
thn
icit
y L
AC
, 201
0 -2
011
0
0.1
0.2
0.3
0.4
0.5
Whi
teB
lack
Asi
anH
ispa
nic
Rac
e/E
thn
icit
y
Cases per 100,000
2010
2011
Fig
ure
4.
Rep
ort
ed S
eve
re S
. au
reu
s C
ases
by
Mo
nth
of
On
set
LA
C, 2
010-
2011
01234567
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Mo
nth
Number of Cases2
01
0
20
11
*Rat
es c
alcu
late
d ba
sed
on le
ss th
an 1
9 ca
ses
or e
vent
s ar
e co
nsid
ered
unr
elia
ble
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
Pag
e 18
4
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2011
Ann
ual M
orbi
dity
Rep
ort
Tab
le 2
. F
req
uen
cy
and
Per
cen
tag
e o
f S
eve
re S
. au
reu
s C
lin
ical
S
ynd
rom
es,
LA
C,
2011
Syn
drom
e N
umbe
r P
erce
nt*
Bac
tere
mia
(with
out f
ocus
) 26
59
Pne
umon
ia
19
43
Sep
tic e
mbo
li 5
11
Wou
nd In
fect
ion
4 9
Ski
n In
fect
ion
3 7
End
ocar
ditis
2
5
Ost
eom
yelit
is
1 2
Men
ingi
tis
1 2
Oth
er
7 16
*Ove
rlapp
ing
synd
rom
es w
ill to
tal o
ver 1
00%
.
Tab
le 1
. S
eve
re S
. au
reu
s R
isk
Fac
tors
by
Dat
e o
f O
nse
t,
20
10
-20
11
20
10
N =
28
2011
N
= 4
4 %
* %
* D
iabe
tes
32
32
Cur
rent
Sm
oker
4
16
Intra
veno
us D
rug
Use
4
11
Hea
rt Fa
ilure
/CH
F 0
9 Li
ver D
isea
se
14
9 A
lcoh
ol A
buse
4
9 A
sthm
a 4
9 E
mph
ysem
a 0
7 M
alig
nanc
y 0
5 H
IV/A
IDS
4
2 C
hron
ic R
enal
Insu
ffici
ency
0
2 O
ther
Ski
n C
ondi
tion
4 0
Oth
er
29
39
Non
e 39
18
*Ove
rlapp
ing
risk
fact
ors
will
tota
l ove
r 100
%.
MS
SA
**
57%
M
RS
A*
36%
Unkno
wn
7%
*MR
SA
=Met
hici
llin R
esis
tanc
e S
taph
yloc
occu
s au
reus
**
MS
SA
=Met
hici
llin S
ensi
tive
Sta
phyl
ococ
cus
aure
us
Fig
ure
5.
Per
cen
t C
ases
of
Sev
ere
S.
aure
us
Infe
ctio
n
by
Me
thic
illi
n-R
esis
tan
ce T
ype
L
AC
, 201
1 (N
=44
)
Severe Staphylococcus Aureus page 179
Acute Communicable Disease Control 2010 Annual Morbidity Report
SEVERE STAPHYLOCOCCUS AUREUS INFECTIONIN PREVIOUSLY HEALTHY PERSONS
aCases per 100,000 population.
bNot notifiable.
DESCRIPTION
Staphylococcus aureus is a well known bacterial cause of skin infections, causing boils, abscesses, and cellulitis. Infection can result in severe illness, including invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection like pyomyositis and osteomyelitis, severe pneumonia, empyema, necrotizing pneumonia, disseminated infections with septic emboli, bacteremia, sepsis syndrome, and death. For surveillance purposes, severe S. aureus infection in a previously healthy person is defined as isolation of S. aureus from either a sterile or non-sterile site in a patient that has died or has been admitted to the hospital intensive care unit (ICU). In addition, the patient must be previously healthy, (i.e., no hospitalizations, surgery, dialysis, residence in long-term care, or percutaneous device/indwelling catheter within the past year).
Staphylococcus aureus is one of the most common bacterial causes of skin infections that result in a visit to a doctor or the hospital. However, most of these infections do not result in ICU admission or death. Therefore, the data presented in this report underestimate all disease caused by this organism in Los Angeles County (LAC).
2010 TRENDS AND HIGHLIGHTS
Cases aged less than one year had the highest rate (0.7 per 100,000) followed by cases aged 45-54 years (0.5 per 100,000), and cases aged greater than 65 years (0.5 per 100,000) (Figure 1).
Blacks (0.5 per 100.000) and whites (0.5 per 100,000) had the highest rates of severe S. aureusinfection. Hispanics had the lowest rate at 0.1 cases per 100,000 (Figure 2).
The incidence rates for all eight SPAs ranged from 0.2 per 100,000 to 0.3 per 100,000 (Figure 3). The number of cases of severe S. aureus infection peaked during the month of November (Figure 4). The percentage of S. aureus infections resistant to methicillin was 39% (Figure 5). Diabetes and liver disease were reported more than any other risk factors (Table 1). Severe S. aureus cases presented most often with bacteremia, and pneumonia (Table 2). Forty-three percent of cases were reported by only four hospitals in LAC. Thus, underreporting of
severe S. aureus infections in LAC is likely.
CRUDE DATA
Number of Cases 28
Annual Incidence
LA Countya 0.29
Californiab N/A
United Statesb N/A
Age at Diagnosis
Mean 42
Median 46
Range 0-88 years
2010 Annual Morbidity Report
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
page
180
Acu
te C
omm
unic
able
Dis
ease
Con
trol
20
10 A
nnua
l Mor
bidi
ty R
epor
t
Rep
ort
ed S
ever
e S
tap
hyl
oco
ccu
s A
ure
us
Ca
ses
and
Rat
es*
per
100
,000
by
Ag
e G
rou
p,
Rac
e/E
thn
icit
y, a
nd
SP
A
Lo
s A
ng
eles
Co
un
ty,
200
8-20
10
20
06
2
00
7
20
08
(N
=2
5)
20
09
(N
=2
7)
20
10
(N
=2
8)
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
No.
(%
) Rat
e/
100,
000
Ag
e G
rou
p
<1
N/A
N
/A
N/A
N
/A
N/A
N
/A
1 4.
0 0.
7 0
0.0
0.0
1 4.
0 0.
7 1-
4N
/A
N/A
N
/A
N/A
N
/A
N/A
0
0.0
0.0
1 3.
7 0.
2 0
0.0
0 5-
14N
/A
N/A
N
/A
N/A
N
/A
N/A
2
8.0
0.1
2 7.
4 0.
1 3
10.7
0.
2 15
-34
N/A
N
/A
N/A
N
/A
N/A
N
/A
1 4.
0 0.
0 5
18.5
0.
2 6
21.4
0.
2 35
-44
N/A
N
/A
N/A
N
/A
N/A
N
/A
2 8.
0 0.
1 3
11.1
0.
1 3
10.7
0.
2 45
-54
N/A
N
/A
N/A
N
/A
N/A
N
/A
7 28
.0
0.5
6 22
.2
0.4
7 25
.0
0.5
55-6
4 N
/A
N/A
N
/A
N/A
N
/A
N/A
4
16.0
0.
4 4
14.8
0.
4 3
10.7
0.
3 65
+N
/A
N/A
N
/A
N/A
N
/A
N/A
8
32.0
0.
8 6
22.2
0.
6 5
17.9
0.
5 U
nkno
wn
N/A
N
/A
N/A
N
/A
N/A
N
/A
0 0.
0
0 0.
0
0 0.
0
Rac
e/Et
hn
icit
y
Asi
anN
/A
N/A
N
/A
N/A
N
/A
N/A
3
12.0
0.
2 1
3.7
0.1
4 14
.2
0.3
Bla
ck
N/A
N
/A
N/A
N
/A
N/A
N
/A
4 16
.0
0.5
3 11
.1
0.4
4 14
.2
0.5
His
pani
c N
/A
N/A
N
/A
N/A
N
/A
N/A
5
20.0
0.
1 12
44
.4
0.3
7 25
.0
0.1
Whi
teN
/A
N/A
N
/A
N/A
N
/A
N/A
13
52
.0
0.4
11
40.7
0.
4 13
46
.4
0.5
Oth
erN
/A
N/A
N
/A
N/A
N
/A
N/A
0
0.0
0.0
0 0.
0 0.
0 0
0.0
0.0
Unk
now
n N
/A
N/A
N
/A
N/A
N
/A
N/A
0
0.0
0
0.0
0
0.0
S
PA
1N
/A
N/A
N
/A
N/A
N
/A
N/A
2
8.0
0.5
3 11
.1
0.8
1 4.
0
0.3
2N
/A
N/A
N
/A
N/A
N
/A
N/A
5
20.0
0.
2 2
7.4
0.1
6 21
.4
0.
33
N/A
N
/A
N/A
N
/A
N/A
N
/A
8 32
.0
0.5
4 14
.8
0.3
6 21
.4
0.
34
N/A
N
/A
N/A
N
/A
N/A
N
/A
1 4.
0 0.
1 3
11.1
0.
2 4
14.2
0.3
5N
/A
N/A
N
/A
N/A
N
/A
N/A
3
12.0
0.
5 1
3.7
0.2
2 7.
1 0.
36
N/A
N
/A
N/A
N
/A
N/A
N
/A
2 8.
0 0.
2 9
33.3
0.
9 2
7.1
0.2
7
N/A
N
/A
N/A
N
/A
N/A
N
/A
1 4.
0 0.
1 2
7.4
0.1
4 14
.2
0.3
8N
/A
N/A
N
/A
N/A
N/A
N
/A
312
.0
0.3
2
7.4
0.2
2
7.1
0.2
Unk
now
n N
/A
N/A
N
/A
N/A
N/A
N
/A
0.0
1
1
*Rat
es c
alcu
late
d ba
sed
on le
ss t
han
19 c
ases
or
even
ts a
re c
onsi
dere
d un
relia
ble.
2010
Ann
ual M
orbi
dity
Rep
ort
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
page
181
Acu
te C
omm
unic
able
Dis
ease
Con
trol
20
10 A
nnua
l Mor
bidi
ty R
epor
t
Fig
ure
1.
In
cid
en
ce
Ra
tes
* o
f S
eve
re S
. au
reu
sIn
fec
tio
n b
y A
ge
G
rou
p L
AC
, 2
01
0 (
N=
28
)
0
0.2
0.4
0.6
0.8
<1
1-4
5-1
415
-34
35-4
445
-54
55-6
465
+
Ag
e G
rou
p i
n Y
ears
Cases per 100,000
Fig
ure
3.
In
cid
en
ce
Ra
tes
* o
f S
eve
re S
. a
ure
us
In
fec
tio
n b
y S
PA
LA
C,
20
10
(N=
28
)
0
0.2
0.4
12
34
56
78
SP
A
Cases per 100,000
Fig
ure
2.
Se
vere
S.
au
reu
sIn
fec
tio
n I
nc
ide
nc
e R
ate
s*
by
Ra
ce
/Eth
nic
ity
LA
C,
20
10
(N
=2
8)
0
0.1
0.2
0.3
0.4
0.5
Wh
iteB
lack
Asi
anH
ispa
nic
Rac
e/E
thn
icit
y
Cases per 100,000
Fig
ure
4.
Re
po
rte
d S
eve
re S
. au
reu
s C
as
es
by
Mo
nth
of
On
se
tL
AC
, 20
10 (
N=
28)
012345678
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Mo
nth
Number of Cases
*Rat
es c
alcu
late
d ba
sed
on le
ss th
an 1
9 ca
ses
or e
vent
s ar
e co
nsid
ered
un
relia
ble
2010
Ann
ual M
orbi
dity
Rep
ort
Sev
ere
Sta
phyl
ococ
cus
Aur
eus
page
182
Acu
te C
omm
unic
able
Dis
ease
Con
trol
20
10 A
nnua
l Mor
bidi
ty R
epor
t
x
Tab
le 2
. F
req
uen
cy a
nd
Per
cen
tag
e o
f S
ever
eS
. au
reu
s C
linic
al
Syn
dro
me
s, L
AC
, 2
010
Syn
drom
e N
umbe
r P
erce
nt*
Bac
tere
mia
(w
ithou
t foc
us)
16
57
Pne
umon
ia
11
40
Sep
tic e
mbo
li 4
14
Wou
nd In
fect
ion
4 14
End
ocar
ditis
4
14
Ski
n In
fect
ion
3 11
Ost
eom
yelit
is
2 7
Men
ingi
tis
1 4
Sep
tic A
rthr
itis
1 4
Oth
er
6 21
*Ove
rlapp
ing
syn
drom
es w
ill to
tal o
ver
100%
.
Tab
le 1
. S
eve
reS
. au
reu
s R
isk
Fac
tors
by
Dat
e o
f O
nse
t,
200
9-20
10
200
9
N =
27
201
0
N =
28
%*
%*
Dia
bet
es
15
32
Cur
rent
Sm
oke
r 7
4
Em
phys
ema
0
0
Alc
ohol
Ab
use
0
4
Ast
hma
4 4
Intr
aven
ous
Dru
g U
se
15
4
HIV
/AID
S
4 4
Mal
igna
ncy
4 0
Live
r D
isea
se
0 14
Oth
er S
kin
Con
ditio
n 0
4
Oth
er
41
29
Non
e
22
39
*Ove
rlapp
ing
risk
fact
ors
will
tota
l ove
r 10
0%.
MS
SA
**
61%
MR
SA
*
39%
*MR
SA
=M
ethi
cilli
n R
esis
tanc
e S
taph
yloc
occu
s au
reus
**
MS
SA
=M
ethi
cilli
n S
ensi
tive
Sta
phyl
ococ
cus
aure
us
Fig
ure
5.
Per
cen
t C
ases
of
Se
vere
S.
aure
us
Infe
ctio
nb
y M
eth
icill
in-R
esis
tan
ce T
ype
LA
C, 2
010
(N
=28
)
2010
Ann
ual M
orbi
dity
Rep
ort
Staphylococcus Aureus Infection, SeverePage 165
Acute Communicable Disease Control2009 Annual Morbidity Report
SEVERE STAPHYLOCOCCUS AUREUS INFECTION IN PREVIOUSLY HEALTHY PERSONS
aCases per 100,000 population.
DESCRIPTION
Staphylococcus aureus is a well known bacterial cause of skin infections, causing boils, abscesses, and cellulitis. Infection can result in severe illness, including invasive skin and soft-tissue infection, necrotizing fasciitis, musculoskeletal infection like pyomyositis and osteomyelitis, severe pneumonia, empyema, necrotizing pneumonia, disseminated infections with septic emboli, bacteremia, sepsis syndrome, and death. Statewide surveillance of severe S. aureus infections in previously healthy persons began in February 2008. For surveillance purposes, severe S. aureus infection in a previously healthy person is defined as isolation of S. aureus from either a sterile or non-sterile site in a patient that has died or has been admitted to the hospital intensive care unit (ICU). In addition, the patient must be previously healthy, (i.e., no hospitalizations, surgery, dialysis, residence in long-term care, or percutaneous device/indwelling catheter within the past year).
Staphylococcus aureus is one of the most common bacterial causes of skin infections that result in a visit to a doctor or the hospital. However, most of these infections do not result in ICU admission or death.Therefore, the data presented in this report underestimate all disease caused by this organism in Los Angeles County (LAC).
2009 TRENDS AND HIGHLIGHTS
Cases aged 65 years and older had the highest rate (0.6 per 100,000) followed by cases aged 45-54 years and 55-64 years both groups of which had a rate of 0.4 cases per 100,000 (Figure 1).Blacks and whites had the highest rates of severe S. aureus infection at 0.4 cases per 100,000.Asians had the lowest rate at 0.1 cases per 100,000 (Figure 2).Service Planning Areas (SPAs) 1 and 6 had the highest rates of severe S. aureus infection at 0.8 and 0.9 cases per 100,000, respectively (Figure 3).The number of cases of severe S. aureus infection peaked during the month of February (Figure 4).The percentage of S. aureus infections resistant to methicillin was 59% (Figure 5).Diabetes and intravenous drug use were reported more than any other risk factors (Table 1).Severe S. aureus cases presented most often with pneumonia, wound infections, and skin infections(Table 2).Forty-one percent of cases were reported by only three hospitals in LAC. Thus, it is suspected that there has been significant underreporting of severe S. aureus infections in LAC.
CRUDE DATA
Number of Cases 27
Annual Incidence
LA Countya 0.28
California N/A
United States N/A
Age at Diagnosis
Mean 46
Median 48
Range 1 - 90 years
2009 Annual Morbidity Report
Sta
phyl
ococ
cus
Aur
eus
Infe
ctio
n, S
ever
eP
age
166
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2009
Ann
ual M
orbi
dity
Rep
ort
Rep
ort
ed S
ever
e S
tap
hyl
oco
ccu
s A
ure
us
Cas
es a
nd
Rat
es*
per
100
,000
by
Ag
e G
rou
p,
Rac
e/E
thn
icit
y, a
nd
SP
AL
os
An
gel
es C
ou
nty
, 20
05-2
009
20
05
20
06
20
07
20
08
(N
=2
5)
20
09
(N
=2
7)
No.
(%)
Rat
e/10
0,00
0N
o.(%
)Rat
e/10
0,00
0N
o.(%
)Rat
e/10
0,00
0N
o.(%
)Rat
e/10
0,00
0N
o.(%
)Rat
e/10
0,00
0
Ag
e G
rou
p
<1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
14.
00.
70
0.0
0.0
1-4
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
00.
00.
01
3.7
0.2
5-14
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
28.
00.
12
7.4
0.1
15-3
4N
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A1
4.0
0.0
518
.50.
235
-44
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
28.
00.
13
11.1
0.1
45-5
4N
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A7
28.0
0.5
622
.20.
455
-64
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
416
.00.
44
14.8
0.4
65+
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
832
.00.
86
22.2
0.6
Unk
now
nN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A0
0.0
00.
0R
ace/
Eth
nic
ity
Asi
anN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A3
12.0
0.2
13.
70.
1Bla
ckN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A4
16.0
0.5
311
.10.
4H
ispa
nic
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
520
.00.
112
44.4
0.3
Whi
teN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A13
52.0
0.4
1140
.70.
4O
ther
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
00.
00.
00
0.0
0.0
Unk
now
nN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A0
0.0
00.
0S
PA 1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
28.
00.
53
11.1
0.8
2N
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A5
20.0
0.2
27.
40.
13
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
832
.00.
54
14.8
0.3
4N
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A1
4.0
0.1
311
.10.
25
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
312
.00.
51
3.7
0.2
6N
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A2
8.0
0.2
933
.30.
97
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
14.
00.
12
7.4
0.1
8N
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A 3
12.0
0.3
2
7.4
0.2
Unk
now
nN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/AN
/A 0
0.0
1
*Rat
es c
alcu
late
d ba
sed
on le
ss t
han
19 c
ases
or
even
ts a
re c
onsi
dere
d un
relia
ble.
2009
Ann
ual M
orbi
dity
Rep
ort
Sta
phyl
ococ
cus
Aur
eus
Infe
ctio
n, S
ever
eP
age
167
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2009
Ann
ual M
orbi
dity
Rep
ort
Fig
ure
1.
In
cid
ence
Rat
es o
f S
eve
re S
. au
reu
s I
nfe
ctio
n b
y A
ge
Gro
up
LA
C,
20
09
(N
=2
7)
0
0.2
0.4
0.6
0.8
<1
1-4
5-14
15-3
435
-44
45-5
455
-64
65+
Ag
e G
rou
p i
n Y
ears
Cases per 100,000
Fig
ure
3.
In
cid
en
ce
Ra
tes
of
Se
vere
S.
aure
us
In
fect
ion
by
SP
AL
AC
, 2
00
9 (
N=
27
)
0
0.2
0.4
0.6
0.81
12
34
56
78
SP
A
Cases per 100,000
Fig
ure
2.
Sev
ere
S.
aure
us
In
fec
tio
n I
nc
ide
nc
e R
ate
s b
y R
ac
e/E
thn
icit
y L
AC
, 2
00
9 (
N=
27
)
0
0.1
0.2
0.3
0.4
0.5
Whi
teB
lack
Asi
anH
ispa
nic
Rac
e/E
thn
icit
y
Cases per 100,000
Fig
ure
4.
Rep
ort
ed S
eve
re S
. au
reu
s C
as
es
by
Mo
nth
of
On
se
tL
AC
, 2
00
9 (
N=
27
)
0123456
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Mo
nth
Number of Cases
2009
Ann
ual M
orbi
dity
Rep
ort
Sta
phyl
ococ
cus
Aur
eus
Infe
ctio
n, S
ever
eP
age
168
Acu
te C
omm
unic
able
Dis
ease
Con
trol
2009
Ann
ual M
orbi
dity
Rep
ort
Ta
ble
2.
Fre
qu
en
cy
an
d P
erc
en
tag
e o
f S
eve
reS
. au
reu
sC
lin
ica
l S
ynd
rom
es
, L
AC
, 2
00
9
Syn
drom
eN
umbe
rP
erce
nt*
Pne
umon
ia12
44
Bac
tere
mia
(w
ithou
t fo
cus)
311
Wou
nd In
fect
ion
519
Ski
nIn
fect
ion
519
Men
ing
itis
311
Sep
tic A
rthr
itis
14
Ost
eom
yelit
is1
4
Bur
sitis
00
End
ocar
ditis
27
*Ove
rlapp
ing
synd
rom
es w
ill to
tal o
ver
100%
.
Tab
le 1
.P
erce
nta
ge
of
Sev
ere
S.
aure
us
Ris
k F
ac
tors
B
as
ed
on
Da
te o
f O
ns
et
Be
twe
en
1/1
/08
-12
/31/
20
09
20
08
N =
25
20
09
N =
27
%**
%**
Dia
be
tes
28
15
Cu
rre
nt
Sm
oke
r2
87
Em
ph
ysem
a2
00
Alc
oho
l Abu
se1
60
Ast
hm
a1
64
Intr
ave
nou
s D
rug
Use
81
5
HIV
/AID
S4
4
Ma
lign
an
cy4
4
Oth
er
24
41
No
ne
16
22
*Per
sons
with
unk
now
n ris
k fa
ctor
info
rmat
ion
excl
uded
.**
Ove
rlapp
ing
risk
fact
ors
will
tota
l ove
r 10
0%.
Fig
ure
5.
Per
cen
t C
ases
of
Sev
ere
S.
aure
us
Infe
cti
on
by
Typ
eL
AC
, 2
00
9 (
N=
27
)
MR
SA
*
59%
MS
SA
**
37%
Unk
now
n
4%
*MR
SA
=M
ethi
cilli
n R
esis
tanc
e S
taph
yloc
occu
s au
reus
**M
SS
A=
Met
hici
llin
Sen
sitiv
e S
taph
yloc
occu
s au
reus
2009
Ann
ual M
orbi
dity
Rep
ort