Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T00:25:43.708Z Has data issue: false hasContentIssue false
  • English
  • Français

Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012

Published online by Cambridge University Press:  19 January 2016

Andrew E. Simor ,
Linda Pelude ,
George Golding ,
Rachel Fernandes ,
Elizabeth Bryce ,
Charles Frenette ,
Denise Gravel ,
Kevin Katz ,
Allison McGeer  and
Michael R. Mulvey
...Show all authors
Andrew E. Simor*
Affiliation:
Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario
Linda Pelude
Affiliation:
Public Health Agency of Canada, Ottawa, Ontario
George Golding
Affiliation:
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
Rachel Fernandes
Affiliation:
Public Health Agency of Canada, Ottawa, Ontario
Elizabeth Bryce
Affiliation:
Vancouver Coastal Health, Vancouver, British Columbia
Charles Frenette
Affiliation:
McGill University Health Centre, Montreal, Quebec
Denise Gravel
Affiliation:
Public Health Agency of Canada, Ottawa, Ontario
Kevin Katz
Affiliation:
North York General Hospital, Toronto, Ontario
Allison McGeer
Affiliation:
Mount Sinai Hospital, Toronto, Ontario
Michael R. Mulvey
Affiliation:
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
Stephanie Smith
Affiliation:
University of Alberta, Edmonton, Alberta
Karl Weiss
Affiliation:
Maisonneuve-Rosemont Hospital, Montreal, Quebec.
*
Address correspondence to Andrew Simor, MD, Department of Microbiology, Sunnybrook Health Sciences Centre, B103-2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Bloodstream infection (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with considerable morbidity and mortality.

OBJECTIVE

To determine the incidence of MRSA BSI in Canadian hospitals and to identify variables associated with increased mortality.

METHODS

Prospective surveillance for MRSA BSI conducted in 53 Canadian hospitals from January 1, 2008, through December 31, 2012. Thirty-day all-cause mortality was determined, and logistic regression analysis was used to identify variables associated with mortality.

RESULTS

A total of 1,753 patients with MRSA BSI were identified (incidence, 0.45 per 1,000 admissions). The most common sites presumed to be the source of infection were skin/soft tissue (26.6%) and an intravascular catheter (22.0%). The most common spa types causing MRSA BSI were t002 (USA100/800; 55%) and t008 (USA300; 29%). Thirty-day all-cause mortality was 23.8%. Mortality was associated with increasing age (odds ratio, 1.03 per year [95% CI, 1.02–1.04]), the presence of pleuropulmonary infection (2.3 [1.4–3.7]), transfer to an intensive care unit (3.2 [2.1–5.0]), and failure to receive appropriate antimicrobial therapy within 24 hours of MRSA identification (3.2 [2.1–5.0]); a skin/soft-tissue source of BSI was associated with decreased mortality (0.5 [0.3–0.9]). MRSA genotype and reduced susceptibility to vancomycin were not associated with risk of death.

CONCLUSIONS

This study provides additional insight into the relative impact of various host and microbial factors associated with mortality in patients with MRSA BSI. The results emphasize the importance of ensuring timely receipt of appropriate antimicrobial agents to reduce the risk of an adverse outcome.

Infect. Control Hosp. Epidemiol. 2016;37(4):390–397

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 4 , April 2016 , pp. 390 - 397
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

A list of members of the Canadian Nosocomial Infection Surveillance Program who participated in the surveillance for methicillin-resistant Staphylococcus aureus bloodstream infection appears at the end of the text.

Presented in part: IDWeek 2013; San Francisco, CA; October 3, 2013 (Abstract 383).

References

REFERENCES

1. Dantes, R, Mu, Y, Bellflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970–1978.Google Scholar
2. Johnson, AP, Davies, J, Guy, R, et al. Mandatory surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in England: the first 10 years. J Antimicrob Chemother 2012;67:802–809.CrossRefGoogle ScholarPubMed
3. Köck, R, Becker, K, Cookson, B, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 2010;15:19688.CrossRefGoogle ScholarPubMed
4. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin-resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
5. De Kraker, MEA, Wolkewitz, M, Davey, PG, Grundmann, H. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011;55:1598–1605.Google Scholar
6. Soriano, A, Marco, F, Martinez, JA, et al. Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2008;46:193–200.CrossRefGoogle ScholarPubMed
7. Kempker, RR, Farley, MM, Ladson, JL, Satola, S, Ray, SM. Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA bacteremia. J Infect 2010;61:372–381.CrossRefGoogle ScholarPubMed
8. Walraven, CJ, North, MS, Marr-Lyon, L, Deming, P, Sakoulas, G, Mercier, R-C. Site of infection rather than vancomycin MIC predicts vancomycin treatment failure in methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2011;66:2386–2392.CrossRefGoogle ScholarPubMed
9. Pastagia, M, Kleinman, LC, Lacerda de la Cruz, EG, Jenkins, SG. Predicting risk for death from MRSA bacteremia. Emerg Infect Dis 2012;18:1072–1080.Google Scholar
10. Gasch, O, Camoez, M, Dominguez, MA, et al. Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism, and therapy. Clin Microbiol Infect 2013;19:1049–1057.Google Scholar
11. Simor, AE, Gilbert, NL, Gravel, D, et al. Methicillin-resistant Staphylococcus aureus colonization and infection in Canada: national surveillance and changing epidemiology, 1995-2007. Infect Control Hosp Epidemiol 2010;31:348–356.Google Scholar
12. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
13. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791–797.CrossRefGoogle ScholarPubMed
14. Liu, C, Bayer, A, Cosgrove, SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18–e55.Google Scholar
15. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 23rd informational supplement. CLSI document. Wayne, PA: CLSI, 2013:M100-S23.Google Scholar
16. Golding, GR, Campbell, JL, Spreitzer, DJ, et al. A preliminary guideline for the assignment of methicillin-resistant Staphylococcus aureus to a Canadian pulsed-field gel electrophoresis epidemic type using spa typing. Can J Infect Dis Med Microbiol 2008;19:273–281.Google Scholar
17. Gasch, O, Camoez, M, Domínguez, MA, et al. Predictive factors for early mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2013;68:1423–1430.CrossRefGoogle ScholarPubMed
18. Nair, R, Ammann, E, Rysavy, M, Schweizer, ML. Mortality among patients with methicillin-resistant Staphylococcus aureus USA300 versus non-USA300 infections: a meta-analysis. Infect Control Hosp Epidemiol 2014;35:31–41.Google Scholar
19. Klein, EY, Sun, L, Smith, DL, Laxminarayan, R. The changing epidemiology of methicillin-resistant Staphylococcus aureus in the United States: a national observational study. Am J Epidemiol 2013;177:666–674.Google Scholar
20. David, MZ, Daum, RS, Bayer, AS, et al. Staphylococcus aureus bacteremia at 5 US academic medical centers, 2008-2011: significant geographic variation in community-onset infections. Clin Infect Dis 2014;59:798–807.CrossRefGoogle ScholarPubMed
21. Jarvis, WR, Jarvis, AA, Chinn, RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012;40:194–200.Google Scholar
22. Widmer, AF, Lakatos, B, Frei, R. Strict infection control leads to low incidence of methicillin-resistant Staphylococcus aureus bloodstream infection over 20 years. Infect Control Hosp Epidemiol 2015;36:702–709.Google Scholar
23. Williams, V, Simor, AE, Kiss, A, et al. Is the prevalence of antibiotic-resistant organisms changing in Canadian hospitals? Comparison of point-prevalence survey results in 2010 and 2012. Clin Microbiol Infect 2015;21:553–559.CrossRefGoogle ScholarPubMed
24. Wang, J-T, Wang, J-L, Fang, C-T, et al. Risk factors for mortality of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection: with investigation of the potential role of community-associated strains. J Infect 2010;61:449–457.Google Scholar
25. Kalil, AC, Van Schooneveld, TC, Fey, PD, Rupp, ME. Association between vancomycin minimum inhibitory concentration and mortality among patients with Staphylococcus aureus bloodstream infections: a systematic review and meta-analysis. JAMA 2014;312:1552–1564.Google Scholar
26. Tattevin, P, Schwartz, BS, Graber, CJ, et al. Concurrent epidemics of skin and soft-tissue infection and bloodstream infection due to community-associated methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2012;55:781–788.CrossRefGoogle ScholarPubMed
27. van Hal, SJ, Lodise, TP, Paterson, DL. The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections. Clin Infect Dis 2012;54:755–771.Google Scholar
28. van Hal, SJ, Paterson, DL. Systematic review and meta-analysis of the significance of heterogeneous vancomycin-intermediate Staphylococcus aureus isolates. Antimicrob Agents Chemother 2011;55:405–410.Google Scholar
29. Robinson, JO, Phillips, M, Christiansen, KJ, Pearson, JC, Coombs, GW, Murray, RJ. Knowing prior methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization status increased the empirical use of glycopeptides in MRSA bacteraemia and may decrease mortality. Clin Microbiol Infect 2014;20:530–535.CrossRefGoogle ScholarPubMed
30. Paul, M, Kariv, G, Goldberg, E, et al. Importance of appropriate empirical antibiotic therapy for methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2010;65:2658–2665.CrossRefGoogle ScholarPubMed
31. Kim, SH, Park, WB, Lee, CS, et al. Outcome of inappropriate empirical antibiotic therapy in patients with Staphylococcus aureus bacteraemia: analytical strategy using propensity scores. Clin Microbiol Infect 2006;12:13–21.CrossRefGoogle ScholarPubMed
32. Schweizer, ML, Furuno, JP, Harris, AD, et al. Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study. PLOS ONE 2010;5:e11432.CrossRefGoogle Scholar
33. Hall, RG, Giuliano, CA, Haase, KK, et al. Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study. BMC Infect Dis 2012;12:104.CrossRefGoogle ScholarPubMed
34. Forrester, L, Collet, JC, Mitchell, R, et al. How reliable are national surveillance data? Findings from an audit of Canadian methicillin-resistant Staphylococcus aureus surveillance data. Am J Infect Control 2012;40:102–107.CrossRefGoogle ScholarPubMed
35. Rutledge-Taylor, K, Mitchell, R, Pelude, L, Abdelmalik, P, Roth, V. Evaluation of the representativeness of the Canadian Nosocomial Infection Surveillance Program. Can J Infect Control 2015;30:13–17.Google Scholar
Supplementary material: Image

Simor supplementary material

Figure S2

Download Simor supplementary material(Image)
Image 898.3 KB
Supplementary material: File

Simor supplementary material

Figure S2 Legend

Download Simor supplementary material(File)
File 13.5 KB