Trends in Bacteremia Over 2 Decades in the Top End of the Northern Territory of Australia

Background Information on the local distribution of bloodstream pathogens helps to guide empiric antibiotic selection and can generate hypotheses regarding the effectiveness of infection prevention practices. We assessed trends in bacterial blood culture isolates at Royal Darwin Hospital (RDH) in the Northern Territory of Australia between 1999 and 2019. Methods  Species identification was extracted for all blood cultures first registered at RDH. Thirteen organisms were selected for focused analysis. Trends were examined graphically and using univariable linear regression. Results  Between 1999 and 2019, 189 577 blood cultures from 65 276 patients were processed at RDH. Overall, 6.72% (12 747/189 577) of blood cultures contained a bacterial pathogen. Staphylococcus aureus was the most common cause of bacteremia during the first decade, with an estimated incidence of 96.6 episodes per 100 000 person-years (py; 95% CI, 72.2–121/100 000 py) in 1999. Since 2009, S. aureus bacteremia has declined markedly, whereas there has been an inexorable rise in Escherichia coli bacteremia (30.1 to 74.7/100 000 py between 1999 and 2019; P < .001), particularly in older adults. Since 2017, E. coli has been more common than S. aureus. Rates of Streptococcus pneumoniae bacteremia have reduced dramatically in children, while Burkholderia pseudomallei remained the fourth most common bloodstream isolate overall. Conclusions  The incidence of S. aureus bacteremia, though high by international standards, is declining at RDH, possibly in part due to a sustained focus on both community and hospital infection prevention practices. Gram-negative bacteremia, particularly due to E. coli, is becoming more common, and the trend will likely continue given our aging population.