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≥2g/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.

Infections in Hospitalized Cancer Patients

“…Nearly 80% of catheter-related infections are caused by gram-positive organisms [2]. Staphylococci, streptococci, and enterococci carry the greatest burden of disease [22]. Staphylococcus aureus (S. aureus) infections are generally classified as being caused by methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA).…”

“…Staphylococcus aureus (S. aureus) infections are generally classified as being caused by methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA). While the prevalence of MRSA bloodstream infections is relatively low, the proportion of surgical site infections caused by MRSA has substantially increased over the past 15 years and is associated with alarming mortality rates in neutropenic, adult cancer patients [2,22]. It has also been demonstrated that both MSSA and MRSA infections in non-neutropenic, cancer patients are serious clinical conditions frequently associated with the placement of a central venous catheter or an indwelling urinary catheter [14].…”

“…It has also been demonstrated that both MSSA and MRSA infections in non-neutropenic, cancer patients are serious clinical conditions frequently associated with the placement of a central venous catheter or an indwelling urinary catheter [14]. Various reviews suggest that S. aureus is responsible for 1.3-12% of bacteremia cases, 27% of skin and soft tissue infections, and 26% of pneumonia infections in cancer patients [14,15,22]. Antibiotic treatment of S. aureus infections differs between MSSA and MRSA infections.…”

Exploring the therapeutic potential of staphylococcal phage formulations: Current challenges and applications in phage therapy

“…Owing to the escalating incidences of ‘difficult to treat’ MDR pathogens, the use of conventional antibiotics has proven to be ineffective (Chadha et al, 2021c). According to published reports, this notorious pathogen has been correlated with high mortality rates of 15%–60% (Li et al, 2021). The endless race between the discovery of newer drugs and the development of antibiotic resistance is inclined towards the latter end (Chadha et al, 2021a).…”

Thymbra capitata essential oil has a significant antimicrobial activity against methicillin-resistant Staphylococcus aureus pre-formed biofilms

“…2017; Li et al . 2021). MRSA is included on the ESKAPE pathogens, a group of bacterial species that due to increased acquisition of antimicrobial resistance have been increasingly difficult to treat, with increasing burden of disease and increased death rates due to treatment failure (Oliveira et al .…”