Mortality Associated with Nosocomial Bacteremia Due to Methicillin-Resistant Staphylococcus aureus

Abstract

We prospectively studied all cases of Staphylococcus aureus bacteremia that occurred during an extensive outbreak of methicillin-resistant S. aureus (MRSA) in our hospital over a 4-year period (January 1990 through September 1993). We report the results of a comparative analysis of the clinical characteristics and mortality rates among patients with nosocomial bacteremia caused by MRSA (84 cases) or methicillin-susceptible S. aureus (MSSA; 100 cases). The patients with MRSA bacteremia were older than those with MSSA bacteremia (69 years vs. 54 years, respectively; P < .01) and were more likely than those with MSSA bacteremia to have the following predisposing factors: a prolonged hospitalization (32 days vs. 14 days, respectively; P < .01); prior antimicrobial therapy (61% vs. 34%, respectively; P < .01); urinary catheterization (58% vs. 27%, respectively; P < .01); nasogastric tube placement (31% vs. 13%, respectively; P < .01); and prior surgery (45% vs. 31%, respectively; P = .05). Multivariate analysis with use of the stepwise logistic regression method showed a relationship between mortality and the following variables: methicillin resistance (odds ratio [OR], 3), meningitis (OR, 13), and inadequate treatment (OR, 11).

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

“…and meningitis) are improved by early therapy with active agents against the organisms which are subsequently identified by appropriate culture. Subsequently testing and provision of inadequate therapy is closely correlated with adverse patient outcomes, including increased rates of hospital mortality [39][40][41][42]. Solomkin et al (2004) affirmed that hospitals with more than 20% of MRSA should use vancomycin in empiric treatment [43].…”

Solution insights into the structure of the Efb/C3 complement inhibitory complex as revealed by lysine acetylation and mass spectrometry

“…Staphylococcus aureus is the etiologic agent for a remarkable variety of skin, soft tissue, respiratory, bone, joint, and cardiovascular disorders [7][8][9][10][11]. While many factors are thought to contribute to the ability of S. aureus to cause a range of clinical disease, recent work has indicated that the bacterium can bypass a competent immune response with some degree of efficiency.…”

Occupational Infections

“…22 In this surveillance project, slightly more than one-third of the patients had an MRSA infection, including 13% who were bacteremic. Several studies have documented that MRSA infections are associated with greater mortality rate and length of hospital stay, [28][29][30][31][32] and that after adjustment for comorbidities methicillin resistance is a significant independent risk factor for death. 29,30 MRSA is typically resistant to multiple classes of antibiotics.…”