Comparison of Mortality Associated with Methicillin‐Resistant and Methicillin‐Susceptible<i>Staphylococcus aureus</i>Bacteremia: A Meta‐analysis

Cosgrove, Sara E.; Sakoulas, George; Perencevich, Eli N.; Schwaber, Mitchell J.; Karchmer, Adolf W.; Carmeli, Yehuda

doi:10.1086/345476

Cited by 1,767 publications

(1,105 citation statements)

References 52 publications

Supporting

Mentioning

1,003

Contrasting

Unclassified

Order By: Relevance

“…Studies especially focusing on morbidity differences are limited, while the impact of methicillin resistance on mortality has been extensively studied for SA bacteremia and several-but not all-studies, including two meta-analyses, have reported a real effect. 27,[46][47][48][49] A main reason for this apparent disagreement may be a case-mix effect due to the variety of SA infections included in our study groups and this attenuation phenomenon has also been noted elsewhere. 18 Another reason may be the significantly higher percentage of bloodstream infections in the MSSA group.…”

Section: Outcome Analysismentioning

confidence: 89%

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Baraboutis¹,

Tsagalou²,

Papakonstantinou³

et al. 2011

Braz J Infect Dis

View full text Add to dashboard Cite

Objectives: Both total antimicrobial use and specific antimicrobials have been implicated as risk factors for healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA) infection. The aims of this study were: (I) to explore predictors of a new HCA-MRSA infection in comparison with a new healthcare-associated methicillin-sensitive Staphylococcus aureus (HCA-MSSA); (II) to thoroughly assess the role of recent antibiotic use qualitatively and quantitatively. Methods: The time-period for our study was from October 1997 through September 2001. Through applying strict criteria, we identified two groups of inpatients, one with a new HCA-MRSA infection and one with a new HCA-MSSA infection. We recorded demographic, clinical and antibiotic use-related data up to 30 days before the positive culture date. Results: We identified 127 and 70 patients for each group, respectively. Two logistic regression models were carried out to assess the role of antimicrobial use (qualitatively and quantitatively). In model I, duration of hospital stay, presence of chronic wounds, aminoglycoside and fluoroquinolone use retained statistical significance. In model II, duration of hospital stay and history of intubation during the last month stood out as the only significant predictors of a subsequent HCA-MRSA infection. No significant differences in outcome were noted. Conclusions: The length of exposure to the hospital environment may be the best predictor of a new HCA-MRSA infection. Use of aminoglycosides and fluoroquinolones may also stand independently along with presence of chronic ulcers and surgical procedures. No independent association between quantitative antibiotic use and subsequent HCA-MRSA infection was documented. Keywords: methicillin-resistant Staphylococcus aureus; Staphylococcus aureus; antibacterial agents; fluoroquinolones. significant risk factor for MRSA acquisition and infection from most, but not all, case-control and cohort studies. 4,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Both total antimicrobial use as well as specific antimicrobial classes have been implicated. [11][12][13][14][15][16][17][18]24,25 Included in these classes are β-lactamic antibiotics, 14,26-33 cephalosporins, 11,12,16,22,29 aminoglycosides, 22,33,34 macrolides, 27 glycopeptides 15,[27][28][29]34 and fluoroquinolones (FQs). 6,11,12,14,[26][27][28][29][35][36][37] A relatively recently published meta-analysis detected a clear association between exposure to antibiotics and MRSA isolation. Significant risk ratios were found for FQs, glycopeptides, cephalosporins and other β-lactams. 38 A prediction model, aimed at identifying MRSA bacteremia, predicted that 80% of the nosocomial bacteremias would be resistant to methicillin if patients had experienced antimicrobials prior to the onset. This model also indicated that there were no differences between antibiotics in the prediction of MRSA. 29

show abstract

Section: Outcome Analysismentioning

confidence: 89%

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Baraboutis¹,

Tsagalou²,

Papakonstantinou³

et al. 2011

Braz J Infect Dis

View full text Add to dashboard Cite

show abstract

“…Patients with MRSA bacteremia have been shown to have a higher mortality risk and higher healthcare costs than those with MSSA infections, and a meta-analysis of 31 studies of patients with S. aureus bloodstream infections demonstrated a significant increase in mortality among patients with MRSA vs. MSSA bacteremia. [18][19][20] Outcomes when comparing MRSA and MSSA in VAP are slightly more variable. A higher rate of mortality has been reported in patients with pneumonia caused by MRSA vs. MSSA, but others found no difference after controlling for potential confounders.…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic outcomes in patients with community‐acquired Staphylococcus aureus pneumonia

Taneja

Haque

Oster

et al. 2010

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:While the clinical and economic consequences of S. aureus pneumonia in healthcare settings have been well documented, much less is known about community‐acquired S. aureus pneumonia (CAP).METHODS:We retrospectively identified all patients admitted to a large US urban teaching hospital between January 2005 and May 2008 with pneumonia and positive blood or respiratory cultures for S. aureus within 48 hours of admission. Patients with suspected healthcare‐associated pneumonia (HCAP) were excluded from the study sample, using established criteria (eg, recent hospitalization, admission from nursing home, hemodialysis). Patients were designated as having methicillin‐resistant (MRSA) or methicillin‐susceptible (MSSA) CAP based on initial S. aureus isolates. Initial therapy was designated “appropriate” vs. “inappropriate” based on expected susceptibility of the organism to the regimen received.RESULTS:We identified a total of 128 CAP patients with S. aureus isolates; mean (standard deviation [SD]) age was 60 (17) years. A total of 55 patients (43%) had initial cultures positive for MRSA. Patients with MRSA CAP were more likely to receive inappropriate initial therapy (24 [44%] vs. 13 [18%] for MSSA; P = 0.002). Approximately 25% of all patients underwent surgery for pneumonia, 69% received mechanical ventilation, 79% were admitted to intensive care unit (ICU), and 24% died in hospital. Mean (SD) length of stay was 17.0 (15.7) days, and total hospital charges averaged $127,922 ($154,605) per patient; there were no significant differences between patients with MRSA vs. MSSA CAP.CONCLUSION:Outcomes are poor, hospital stays are long, and costs of care are high in patients with S. aureus CAP, and do not differ between those with MRSA vs. MSSA. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

show abstract

“…Entre los factores relacionados con el tratamiento, se han identificado la resistencia a la meticilina (55,63,64), el retraso en el diagnóstico (52), la persistencia de cuerpos extraños (65,66) o focos no removibles (52,56), la persistencia de la fiebre después de 72 horas (16,56) y el retraso en la administración del antibiótico apropiado por más de 44 horas (63), como factores que predicen una mayor probabilidad de fracaso terapéutico, siembras metastásicas y recurrencia. La mayoría de estos estudios corresponden a estudios de cohorte, con tiempos variables de seguimiento.…”

Section: Factores De Riesgo Y Pronósticosunclassified

“…Debido a la aparición de cepas de S. aureus con resistencia intermedia a la vancomicina o SARV, se han introducido nuevos antibióticos, entre los que se encuentran linezolid (familia oxazolidinona), quinupristin/dalfopristin (familia estreptogramina, no disponible en Colombia), daptomicina (lipopéptido cíclico, no disponible en Colombia), entre otros (1,13,15,33,-34,54,63,64,71,73); no hay que olvidar otros antibióticos como trimetoprim-sulfametoxazol, clindamicina, rifampicina, fluoroquinolonas, teniendo en mente que el gen MecA puede conferir resistencia variable a uno o varios de estos antibióticos (15,18,54,63,64,71,74). Cabe recordar que la vancomicina no se considera tan efectiva como los beta-lactámicos, por lo que siempre que sea posible se debe preferir el uso de penicilinas antiestafilocóccicas antes que de vancomicina (55,75) (cuadro 3).…”

Section: Evidencia De Compromiso Endocárdicounclassified

Enfoque terapéutico de la bacteriemia por Staphylococcus aureus

et al. 2007

View full text Add to dashboard Cite

Staphylococcus aureus es un patógeno importante que causa cerca de 11% a 33% de las bacteriemias hospitalarias y un porcentaje importante de las adquiridas en la comunidad, con una tasa de complicaciones cercana a 50%. En la siguiente revisión se destaca la epidemiología de la bacteriemia por S. aureus, con especial referencia a la situación de este patógeno en Colombia, la frecuencia y los mecanismos de resistencia a los medicamentos más frecuentemente usados en este contexto, y se discuten los elementos semiológicos, clínicos y de laboratorio que influyen en el enfoque diagnóstico y terapéutico de los pacientes con bacteriemia por este microorganismo.Palabras clave: Staphylococcus aureus/patogenicidad, bacteriemia/terapia, bacteriemia/ epidemiología, agentes antibacterianos/uso terapéutico. Therapeutic approach to Staphylococcus aureus bacteremiaStaphylococcus aureus is an important human pathogen, responsible for 11-33% of the bacteremias acquired in the hospital setting and nearly 50% of those acquired in the community at large. The epidemiology of S. aureus bacteremia is discussed, with an special emphasis on the situation in Colombia and the resistance mechanisms against the major drug groups used for the treatment. The clinical keys and laboratory support for the appropriate clinical approaches are presented together with the therapeutic strategies for the treatment of patients with S. aureus bacteremia.

show abstract

Comparison of Mortality Associated with Methicillin‐Resistant and Methicillin‐SusceptibleStaphylococcus aureusBacteremia: A Meta‐analysis

Cited by 1,767 publications

References 52 publications

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Clinical and economic outcomes in patients with community‐acquired Staphylococcus aureus pneumonia

Enfoque terapéutico de la bacteriemia por Staphylococcus aureus

Contact Info

Product

Resources

About