Is methicillin-resistant <em>Staphylococcus Aureus</em> infection associated with higher mortality and morbidity in hospitalized patients? A cohort study of 551 patients from South Western India

Abstract

PurposeTo determine morbidity and mortality of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) infections in a tertiary health care facility.MethodsA cohort study among hospitalized adult patients with culture proven MRSA or MSSA monoinfection were recruited in a tertiary referral center in South India from November 2011 to December 2012.ResultsOf total 551 subjects, 284 (52%) had MRSA and 267 (48%) MSSA infection. A total of 184 (65%) subjects had health care-associated MRSA (HA-MRSA) and 100 (35%) community-associated MRSA (CA-MRSA). Chronic kidney disease and recent antibiotic use had significant association with MRSA. MRSA patients had significant respiratory infection (OR 2.24 [1.04, 5.16]) and bacteremia (OR 2.24 [10.40, 5.16]), relative to MSSA. MSSA group had better survival function compared to MRSA group (P=0.028). Median duration of ICU stays were 5 days (IQR 4, 8) and 2 days (IQR 2, 2) in MRSA and MSSA, respectively. Complications such as acute kidney injury, sepsis, multiorgan dysfunction, need for supportive measures were more in the MRSA group.ConclusionMRSA imposes a huge burden in Indian scenario and HA-MRSA remains the main culprit. Patients with history of chronic kidney disease and recent use of antibiotics were found to be at a higher risk. Patients with MRSA infections tend to have poorer outcomes in terms of longer hospital stay, greater complications, and mortality.

A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-Resistant Staphylococcus aureus Infection in India

“…All of the 40 studies were considered for qualitative as well as the quantitative synthesis of etiological agents. Ultimately, only 34 of 40 studies were included in the MRSA meta-analysis, 8,9,15 -46 as the remaining 6 studies did not include data relevant to MRSA (4 efficacy studies, 1 study that described heteroresistance to vancomycin among methicillin-resistant S. aureus isolates, and 1 survey wherein no exact data on prevalence were presented). 47 -52 Table 1 represents the characteristics of the studies included in the analysis.…”

“…A total of 10 studies 8,16,18,23,28,31,36,38,41,46 identified risk factors and co-morbidities, including diabetes, tuberculosis, malignancy, leprosy, extremes of age, group-house inhabitants, high mean body temperature (101.80°F), history of preceding illness/upper respiratory tract infections/trauma, abnormal laboratory values (hemoglobin [<9.5 g%], erythrocyte sedimentation rate [>35 mm/h], c-reactive protein [>32 mg/dL], leucocytes (>14 000 cells/10 9 L), absolute neutrophil count [(>65%]), immuno-compromised status, hospitalization in the last 3 months, present intake/history of antibiotics, history of surgical procedures, history of alcohol intake and smoking, history of intravenous drugs, history of corticosteroid intake, history of mucocutaneous candidiasis, history of dermatitis, history of sexually transmitted infections, socio-economic status, chronic kidney disease, heart disease, chronic obstructive pulmonary disease, rheumatoid arthritis, MRSA carriage (nasal or axillary or perineal or hand carriage in patients), prolonged duration of hospital stay, and irrational use/over prescription of antibiotics.…”

“…10 Over the past few years, several studies have reported the prevalence of MRSA in different clinical settings within the Indian subcontinent, but the results are inconsistent with limited sample sizes. 8,[11][12][13] Furthermore, few studies from the country suggest an impact of age and gender on MRSA carriage. 14,15 It is imperative to understand the prevalence of risk factors, such as age and gender, on MRSA colonization at the country level to facilitate the implementation of appropriate infection control measures.…”

“…7 Methicillin-resistant S. aureus infection is an emerging infection in the Indian subcontinent with incidence rates of 25% to 50% reported in different parts of the country. 8 According to the multicenter report of the Indian Council of Medical Research (ICMR)—Antimicrobial Resistance Surveillance network presented in 2015, the prevalence of MRSA was reported in the range of 21% to 45% across the centres (Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Puducherry; India Institute of Medical Sciences [AIIMS], New Delhi; Postgraduate Institute of Medical Education and Research [PGIMER], Chandigarh and Christian Medical College [CMC], Vellore), with an overall prevalence of 37.3%. This study also reported a high prevalence of resistance against commonly prescribed antimicrobials including ciprofloxacin (95%) and erythromycin (91%).…”

Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) Carrier in Hemodialysis Patients at Dr. Soetomo Academic General Hospital

“…5 Bacteriemia or infection through the blood caused by S. aureus is a signifi cant cause of high morbidity and mortality. 5,11 Based on the above considerations, the researcher wants to examine the prevalence of MRSA carriers in CKD stage fi ve patients in the Outpatient Clinic and Hemodialysis Installation, as an essential data on the incidence of MRSA carriers.…”