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Rev Panam Salud Publica. 2012 Nov;32(5):343-50.

Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia.

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  • 1Grupo de investigación en enfermedades infecciosas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. jscastillol@unal.edu.co

Abstract

OBJECTIVE:

To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia.

METHODS:

A multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality.

RESULTS:

A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21 mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender.

CONCLUSIONS:

Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.

PMID:
23338691
[PubMed - indexed for MEDLINE]
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