Staphylococcus aureus bacteraemia: incidence, risk factors and predictors for death in a Brazilian teaching hospital

Guilarde, Adriana Oliveira; Turchi, Marília Dalva; Martelli, Celina Maria Turchi; Primo, Mariusa Gomes Borges

doi:10.1016/j.jhin.2006.02.011

Cited by 39 publications

(30 citation statements)

References 31 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study focusing specifically on 30-day mortality but directly comparing MRSA and MSSA patients found a similarly increased ratio (OR, 2.2; CI, 1.0 to 5.0) (3). Three other studies (17,19,27) analyzing the impact of methicillin resistance on hospital mortality using time-to-event methods, but ignoring competing events, also found no impact on the instantaneous risk of dying. Finally, another study (6) supported our finding that patients with MRSA and MSSA infections have equal durations of hospitalization after enrollment.…”

Section: Discussionmentioning

confidence: 97%

Clinical Impact of Antimicrobial Resistance in European Hospitals: Excess Mortality and Length of Hospital Stay Related to Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

Kraker

Wolkewitz

Davey

et al. 2011

Antimicrob Agents Chemother

220

101

View full text Add to dashboard Cite

. Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR ‫؍‬ 2.4) and hospital (aHR ‫؍‬ 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR ‫؍‬ 1.8; P ‫؍‬ 0.04), but not for hospital mortality (HR ‫؍‬ 1.1; P ‫؍‬ 0.63) or LOS (difference ‫؍‬ 0.6 days; P ‫؍‬ 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.The emergence of resistant bacteria is a natural consequence of antibiotic use and complicates the treatment of infected patients. Staphylococcus aureus resistant to isoxazolyl penicillins (methicillin-resistant S. aureus [MRSA]) is one of the most frequent pathogens causing resistant infections in hospitals worldwide (14,21,33). The questions are whether and to what extent resistance affects survival and the duration of hospital admission in patients with bacterial infections. Previous studies compared patients with MRSA infections to those infected by methicillin-susceptible S. aureus (MSSA), using mortality as one of the main endpoints. New insights challenge this approach for a number of reasons.Several studies have shown that patients with MRSA bloodstream infection (BSI) differ in many ways from those with MSSA BSI; they are older, have more comorbidities, and experience longer hospital admissions before the onset of infection (6,22,37). If these two groups of patients are compared directly, bias is introduced, compromising the validity of the results. Of all hospitalized patients at risk of acquiring MRSA BSI, the younger, relatively more healthy MSSA patients are selected as the control group, magnifying the possible impact of resistance (20). Moreover, time-dependent distortions are introduced, as patients staying in the hospital for a shorter period, like MSSA patients, have a smaller chance of acquiring MRSA BSI than patients hospitalized for longer periods, who for many reasons are more likely to die, thus leading to overestimation of the clinical impact of resistance (36).

show abstract

Section: Discussionmentioning

confidence: 97%

Clinical Impact of Antimicrobial Resistance in European Hospitals: Excess Mortality and Length of Hospital Stay Related to Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

Kraker

Wolkewitz

Davey

et al. 2011

Antimicrob Agents Chemother

220

101

View full text Add to dashboard Cite

show abstract

“…including age, underlying illness, the presence of a cardiovascular prosthesis, the presence of metastatic infections, and certain initial conditions (6,18,21,39), they have provided little information that clinicians may use to monitor treatment responses during the course of infection. In light of the high rate of mortality from MRSA bacteremia, it is crucial that new methods and good parameters for the monitoring of MRSA bacteremia be developed (3,6,11,13,14,27).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with cases of bacteremia caused by methicillin-susceptible S. aureus (MSSA) strains, cases of bacteremia caused by MRSA strains have been shown to be associated with more persistent infections, more recurrent episodes, longer hospital stays, and higher rates of mortality (3,6,11,13,14,27). Because of the high rates of mortality and the refractoriness of MRSA bacteremia to treatment, MRSA bacteremia has become a very challenging infectious disease (18,21,38,39,42).It has recently been demonstrated that high bacterial loads in blood correlate with disease severity in patients with infections caused by Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis (4,22,35,41), as well as in a murine model of Serratia marcescens infection (25). In the case of S. aureus-related infections, it was reported that positive blood cultures during follow-up and the persistence of fever were suggestive of a complicated course (6,15,37).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

High Levels of mecA DNA Detected by a Quantitative Real-Time PCR Assay Are Associated with Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

Chang

Lin

et al. 2009

J Clin Microbiol

View full text Add to dashboard Cite

Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is known to be a poor prognostic factor. While several PCR assays for the detection of MRSA in various clinical samples were recently reported, the possibility that a quantitative PCR assay could be used to quantify and monitor MRSA bacteremia has not been explored. In this study, we established a quantitative real-time PCR assay for the mecA gene using known copy numbers of a plasmid containing mecA DNA as a standard and the previously described mecA-specific primers and probe (P. Francois et al., J. Clin. Microbiol. 41:254-260, 2003). We employed this assay to examine 250 sequential whole-blood samples from 20 adult patients, including 13 survivors and 7 nonsurvivors, with culture-proven MRSA bacteremia at the intensive care units of National Taiwan University Hospital between 1 July 2006 and 31 January 2007. The levels of mecA DNA in the nonsurvivors were significantly higher than those in the survivors during the three periods of bacteremia examined (days 0 to 2, 3 to 5, and 6 to 8) (P ‫؍‬ 0.003 by two-tailed Mann-Whitney U test). Moreover, the nonsurvivors had higher mecA DNA levels than the survivors after 3 days and 7 days of anti-MRSA therapy (medians for nonsurvivors and survivors at 3 days, 5.86 and 4.30 log copies/ml, respectively; medians for nonsurvivors and survivors at 7 days, 5.21 and 4.36 log copies/ml, respectively; P ‫؍‬ 0.02 and P ‫؍‬ 0.04, respectively, by two-tailed Mann-Whitney U test). Together, these findings suggest that the level of mecA DNA in blood could potentially be used to monitor MRSA bacteremia and evaluate responses to therapy.Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that is one of the most common causes of both community-acquired and nosocomial infections worldwide, especially in intensive care units (ICUs) (5,8,33,49). In the past two decades, the proportion of MRSA infections has increased dramatically, and up to 60% of S. aureus isolates from ICUs were reported to be methicillin resistant (26). Compared with cases of bacteremia caused by methicillin-susceptible S. aureus (MSSA) strains, cases of bacteremia caused by MRSA strains have been shown to be associated with more persistent infections, more recurrent episodes, longer hospital stays, and higher rates of mortality (3,6,11,13,14,27). Because of the high rates of mortality and the refractoriness of MRSA bacteremia to treatment, MRSA bacteremia has become a very challenging infectious disease (18,21,38,39,42).It has recently been demonstrated that high bacterial loads in blood correlate with disease severity in patients with infections caused by Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis (4,22,35,41), as well as in a murine model of Serratia marcescens infection (25). In the case of S. aureus-related infections, it was reported that positive blood cultures during follow-up and the persistence of fever were suggestive of a complicated course (6,15,37). However, the drastic decrease in the sen...

show abstract

“…Although several SAB cohort studies have not detected any difference in outcomes for patients with one or more comorbidities (32,39,59,89,309,310), this discrepancy probably reflects the small sample size and patient groups selected in these studies. Regardless, overall, the presence of one or more comorbidities generally portends a worse outcome for patients with SAB, and as such, the collection of these data should be encouraged in future SAB studies.…”

Section: Presence Of Comorbiditiesmentioning

confidence: 77%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

View full text Add to dashboard Cite

SUMMARY Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.

show abstract

Staphylococcus aureus bacteraemia: incidence, risk factors and predictors for death in a Brazilian teaching hospital

Cited by 39 publications

References 31 publications

Clinical Impact of Antimicrobial Resistance in European Hospitals: Excess Mortality and Length of Hospital Stay Related to Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

Clinical Impact of Antimicrobial Resistance in European Hospitals: Excess Mortality and Length of Hospital Stay Related to Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

High Levels of mecA DNA Detected by a Quantitative Real-Time PCR Assay Are Associated with Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

Predictors of Mortality in Staphylococcus aureus Bacteremia

Contact Info

Product

Resources

About