Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T00:22:39.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Prediction Model to Identify Patients With Staphylococcus aureus Bacteremia at Risk for Methicillin Resistance

Published online by Cambridge University Press:  02 January 2015

Thomas P. Lodise Jr. ,
Peggy S. McKinnon  and
Michael Rybak
Thomas P. Lodise Jr.
Affiliation:
Anti-Infective Research Laboratory, Detroit Receiving Hospital, Wayne State University, Detroit, Michigan
Peggy S. McKinnon*
Affiliation:
Anti-Infective Research Laboratory, Detroit Receiving Hospital, Wayne State University, Detroit, Michigan
Michael Rybak
Affiliation:
Anti-Infective Research Laboratory, Detroit Receiving Hospital, Wayne State University, Detroit, Michigan
*
Anti-Infective Research Laboratory and Department of Pharmacy Services, Detroit Receiving Hospital, Wayne State University, 4201 St. Antoine Blvd, 1-B UHC, Detroit, MI 48201
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To identify institution-specific risk factors for MRSA bacteremia and develop an objective mechanism to estimate the probability of methicillin resistance in a given patient with Staphylococcus aureus bacteremia (SAB).

Design:

A cohort study was performed to identify institution-specific risk factors for MRSA. Logistic regression was used to model the likelihood of MRSA A stepwise approach was employed to derive a parsimonious model. The MRSA prediction tool was developed from the final model.

Setting:

A 279-bed, level 1 trauma center.

Patients:

Between January 1, 1999, and June 30, 2001, 494 patients with clinically significant episodes of SAB were identified.

Results:

The MRSA rate was 45.5%. Of 18 characteristics included in the logistic regression, the only independent features for MRSA were prior antibiotic exposure (OR, 9.2; CI95, 4.8 to 17.9), hospital onset (OR, 3.0; CI95, 1.9 to 4.9), history of hospitalization (OR, 2.5; CI95, 1.5 to 3.8), and presence of decubitus ulcers (OR, 2.5; CI95, 1.2 to 4.9). The prediction tool was derived from the final model, which was shown to accurately reflect the actual MRSA distribution in the cohort.

Conclusion:

Through multivariate modeling techniques, we were able to identify the most important determinants of MRSA at our institution and develop a tool to predict the probability of methicillin resistance in a patient with SAB. This knowledge can be used to guide empiric antibiotic selection. In the era of antibiotic resistance, such tools are essential to prevent indiscriminate antibiotic use and preserve the longevity of current antimicrobials.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 9 , September 2003 , pp. 655 - 661
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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.)

References

1.Jones, RN, Marshall, SA, Kaller, MA, et al.Nosocomial enterococcal blood stream infections in the SCOPE Program: antimicrobial resistance, species occurrence, molecular testing results, and laboratory testing accuracy. Diagn Microbiol Infeci Dis 1997;29:95–102.Google Scholar
2.Pfaller, MA, Jones, RN, Doern, GV, et al.Survey of blood stream infections attributable to gram-positive cocci: frequency of occurrence and antimicrobial susceptibility of isolates collected in 1997 in the United States, Canada, and Latin America from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis 1999;33:283–297.Google Scholar
3.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin: United States, 1989-1993. JAMA 1993;270:1796.CrossRefGoogle Scholar
4.Rubin, LG, Tucci, V, Cercenado, E, Eliopoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.CrossRefGoogle ScholarPubMed
5.Montecalvo, MA, Horowitz, H, Gedris, C, et al.Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.CrossRefGoogle Scholar
6.Boyce, JM, Opal, SM, Chow, JW, et al.Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.CrossRefGoogle ScholarPubMed
7.Livornese, LL Jr, Dias, S, Samel, C, et al.Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.CrossRefGoogle ScholarPubMed
8.Bhavnani, SM, Drake, JAForrest, A, et al.A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145–158.Google Scholar
9.Sieradzki, K, Roberts, RB, Haber, SW, Tomasz, AThe development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1999;340:517–523.Google Scholar
10.Smith, TL, Pearson, ML, Wilcox, KR, et al.Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999;340:493–501.CrossRefGoogle ScholarPubMed
11.Hiramatsu, K, Hanaki, H, Ino, T, Yabuta, K, Oguri, T, Tenover, FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40:135–136.Google Scholar
12.Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. JAMA 1997;278:461–462.Google Scholar
13.Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 1995;23:87–94.Google Scholar
14.Asensio, A, Guerrero, A, Quereda, C, Lizan, M, Martinez-Ferrer, M. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996;17:20–28.Google Scholar
15.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309–317.Google Scholar
16.Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides: clinical studies. J Infect Dis 1979;139:273–279.Google Scholar
17.Boyce, JM. Methicillin-resistant Staphylococcus aureus: detection, epidemiology, and control measures. Infect Dis Clin North Am 1989;3:901–913.Google Scholar
18.Peacock, JE Jr, Moorman, DR, Wenzel, RP, Mandeli, GL. Methicillin-resistant Staphylococcus aureus: microbiologic characteristics, antimicrobial susceptibilities, and assessment of virulence of an epidemic strain. J Infect Dis 1981;144:575–582.Google Scholar
19.Law, MR, Gill, ON. Hospital-acquired infection with methicillin-resistant and methicillin-sensitive staphylococci. Epidemiol Infect 1988;101:623–629.Google Scholar
20.Hershow, RC, Khayr, WF, Smith, NL. A comparison of clinical virulence of nosocomially acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections in a university hospital. Infect Control Hosp Epidemiol 1992;13:587–593.Google Scholar
21.Warshawsky, B, Hussain, Z, Gregson, DB, et al.Hospital- and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol 2000;21:724–727.Google Scholar
22.Layton, MC, Hierholzer, WJ Jr, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1995;16:12–17.Google Scholar
23.Relio, J, Torres, ARicart, M, et al.Ventilator-associated pneumonia by Staphylococcus aureus: comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 1994;150:1545–1549.CrossRefGoogle Scholar
24.Pujol, M, Pena, C, Pallares, R, Ayats, J, Ariza, J, Gudiol, F. Risk factors for nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1994;13:96–102.Google Scholar
25.Bradley, SF, Terpenning, MS, Ramsey MA et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle ScholarPubMed
26.French, GL, Cheng, AF, Ling, JM, Mo, P, Donnan, S. Hong Kong strains of methicillin-resistant and methicillin-sensitive Staphylococcus aureus have similar virulence. J Hosp Infect 1990;15:117–125.Google Scholar
27.Levine, DP, Crane, LR, Zervos, MJ. Bacteremia in narcotic addicts at the Detroit Medical Center; infectious endocarditis: a prospective comparative study. Rev Infect Dis 1986;8:374–396.Google Scholar
28.Mest, DR, Wong, DH, Shimoda, KJ, Mulligan, ME, Wilson, SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 1994;78:644–650.Google Scholar
29.Muder, RR, Brennen, C, Wagener, MM, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.CrossRefGoogle ScholarPubMed
30.Rezende, NA, Blumberg, HM, Metzger, BS, Larsen, NM, Ray, SM, McGowan, JE Jr. Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 2002;323:117–123.Google Scholar
31.Roghmann, MC, Siddiqui, APlaisance, K, Standiford, H. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect 2001;47:98–103.CrossRefGoogle ScholarPubMed
32.Stamm, AM, Long, MN, Belcher, B. Higher overall nosocomial infection rate because of increased attack rate of methicillin-resistant Staphylococcus aureus. Am J Infect Control 1993;21:70–74.CrossRefGoogle ScholarPubMed
33.Sumrall, B, Nolan, R. Retrospective study of community acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) occurring during an epidemic at a Veterans Affairs Hospital. Infect Control Hosp Epidemiol 1996;17(suppl):P28. Abstract 78.Google Scholar
34.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181–185.CrossRefGoogle ScholarPubMed
35.Sorrell, TC, Packham, DR, Shanker, S, Foldes, M, Munro, R. Vancomycin therapy for methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:344–350.Google Scholar
36.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.CrossRefGoogle ScholarPubMed
37.Salmenlinna, S, Lyytikainen, O, Vuopio-Varkila, J. Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 2002;8:602–607.Google Scholar
38.Lindenmayer, JM, Schoenfeld, S, O'Grady, R, Carney, JK. Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895–899.CrossRefGoogle Scholar
39.Gorak, EJ, Yamada, SM, Brown, JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999;29:797–800.CrossRefGoogle ScholarPubMed
40.L'Heriteau, K, Lucet, JC, Scanvic, A, Bouvet, E. Community-acquired methicillin-resistant Staphylococcus aureus and familial transmission. JAMA 1999;282:1038–1039.Google Scholar
41.Shopsin, B, Mathema, B, Martinez, J, et al.Prevalence of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in the community. J Infect Dis 2000;182:359–362.Google Scholar
42.Moreno, F, Crisp, C, Jorgensen, JH, Patterson, JE. Methicillin-resistant Staphylococcus aureus as a community organism. Clin Infect Dis 1995;21:1308–1312.CrossRefGoogle ScholarPubMed
43.Morta, CA, Hadler, JL. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. J Infect Dis 2001;184:1029–1034.Google Scholar
44.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
45.Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998;158:182–189.Google Scholar
46.Pittet, D, Wenzel, RP. Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177–1184.Google Scholar
47.National Committee for Clinical Laboratory Standards. Methods for Dilutional Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: National Committee for Clinical Laboratory Standards; 1993. Approved standard M7-A3.Google Scholar