Prevalence, predictors, and mortality of bloodstream infections due to methicillin-resistant Staphylococcus aureus in patients with malignancy: systemic review and meta-analysis

Abstract

Background Cancer patients are more likely to develop and die of bloodstream infection (BSI) than noncancer patients. Methicillin-resistant Staphylococcus aureus (MRSA), which is associated with immense mortality and economic burden worldwide, is not covered by the recommended initial antibiotic therapy for cancer patients with BSI. This systemic review was performed to estimate the global methicillin-resistant Staphylococcus aureus (MRSA) prevalence among bacteremia in patients with malignancy, and further study the predictors and mortality of cancer patients with MRSA bacteremia. Methods The PubMed and EMBASE databases were searched for studies published from Jan. 2000 to Mar. 2020 that provided primary data on the prevalence, predictors, or mortality of MRSA bacteremia in cancer patients. A random-effects model meta-analysis was performed to estimate the pooled prevalence of MRSA with 95% confidence intervals (95% CIs). Results The pooled prevalence of MRSA was 3% (95% CI 2–5%) among all bloodstream infections (BSIs) and 44% (95% CI 32–57%) among S. aureus bacteremia in cancer patients. Based on geographical stratification, the pooled prevalence was 5% in Africa (95% CI 1–14%), 1% in Americas (95% CI 1–2%), 2% in Europe (95% CI 1–4%), 4% in Western Pacific (95% CI 2–7%), 8% in South-east Asia (95% CI 4–14%) and 0% in Eastern Mediterranean (95% CI 0–3%). No significant temporal change in MRSA rates was detected in this analysis (R2 = 0.06; P = 0.24). Predictors for MRSA BSIs among cancer patients were identified by comparison with their methicillin-susceptible counterparts, and they were mainly related to healthcare-associated infections and immunosuppression. Finally, the 60-day mortality in adult cancer patients with MRSA BSIs was reported to be 12%, and the 6-month overall mortality was 43.2%, with community-onset infection, secondary BSI, and vancomycin MIC≥2 g/mL being the risk factors for mortality. Conclusions Although the prevalence of MRSA BSIs among cancer patients is relatively low, it did not decline over time as MRSA BSIs in the general hospital population and the high mortality rate was related to MRSA BSIs in patients with malignancy.

Epidemiological Profile and Detection of Resistance Genes in Bloodstream Infection in Cancer Patients: High Occurrence of Metallo-β-lactamases in Enterobacteriales

“…Although MRSA is frequent in ICS in the hospital population 64 , few studies mention the occurrence of MRSA in ICS of cancer patients 65 . The frequency of the mecA gene, in which all showed phenotypic resistance to methicillin, was 46,1% (6/13).…”

Autophagy in Staphylococcus aureus Infection

“…It leads to an increased burden on healthcare-associated expenditures (Zhen et al, 2020), and has become the main cause of bacterial infection in hospitals and communities (Lakhundi and Zhang, 2018). MRSA strains account for 5%-82% of S. aureus isolates (Köck et al, 2010;Falagas et al, 2013), leading to clinical syndromes including bacteremia (Klevens et al, 2007), one of the most severe situations of S. aureus infections with 15%-60% mortality rates (Li et al, 2021). Invasive MRSA strains possess a series of virulence factors and toxins, allowing them to spread rapidly in the community, and seriously threaten public health (Lakhundi et al, 2018).…”

Prevalence of methicillin resistance and superantigenic toxins in Staphylococcus aureus strains isolated from patients with cancer

“…Staphylococcus aureus is one of the most important pathogens in both hospital- and community- acquired infections with significant patient morbidity and mortality rate worldwide [ 1 ]. S. aureus as a potential pathogen causes various infections including superficial and deep skin infections, soft tissue infections, bacteremia, endocarditis, osteomyelitis, pneumonia, toxic- shock syndrome, and staphylococcal scaled skin syndrome [ 2 ]. Over the past several decades, following the introduction of antibiotics, emergence and dissemination of methicillin resistant S. aureus (MRSA) remains a challenging public health issue [ 3 ].…”

“…The capability of MRSA to cause a broad range of human diseases is based on combination of host factors and bacterial virulence factors [ 2 ]. There are several risk factors that cause patients at higher risk for acquisition infections with MRSA including age, length of hospitalization, initial antibiotic treatment, severe underlying disease, surgery and compromised host immunity [ 2 , 6 ].…”

“…The capability of MRSA to cause a broad range of human diseases is based on combination of host factors and bacterial virulence factors [ 2 ]. There are several risk factors that cause patients at higher risk for acquisition infections with MRSA including age, length of hospitalization, initial antibiotic treatment, severe underlying disease, surgery and compromised host immunity [ 2 , 6 ]. Particularly, cancer patients due to impaired cellular immunity, are very prone to serious infections with significant complications particularly with multidrug resistant bacteria (MDRB), and they have multiple predisposing factors that increase the risk of infection; including chemotherapy, radiation therapy, surgery, stem cell transplantation, bone marrow transplantation [ 8 ].…”