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Infect Control Hosp Epidemiol. 2007 Mar;28(3):273-9. Epub 2007 Feb 15.

Comparison of mortality risk associated with bacteremia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus.

Author information

1
Department of Epidemiology and Preventive Medicine, Division of Health Outcomes Research, University of Maryland, School of Medicine, Baltimore, MD 21201, USA. sshurlan@epi.umaryland.edu

Abstract

OBJECTIVE:

To quantify the clinical impact of methicillin-resistance in Staphylococcus aureus causing infection complicated by bacteremia in adult patients, while controlling for the severity of patients' underlying illnesses.

DESIGN:

Retrospective cohort study from October 1, 1995, through December 31, 2003.

PATIENTS AND SETTING:

A total of 438 patients with S. aureus infection complicated by bacteremia from a single Veterans Affairs healthcare system.

RESULTS:

We found that 193 (44%) of the 438 patients had methicillin-resistant S. aureus (MRSA) infection and 114 (26%) died of causes attributable to S. aureus infection within 90 days after the infection was identified. Patients with MRSA infection had a higher mortality risk, compared with patients with methicillin-susceptible S. aureus (MSSA) infections (relative risk, 1.7 [95% confidence interval, 1.3-2.4]; P<.01), except for patients with pneumonia (relative risk, 0.7 [95% confidence interval, 0.4-1.3]). Patients with MRSA infections were significantly older (P<.01), had more underlying diseases (P=.02), and were more likely to have severe sepsis in response to their infection (P<.01) compared with patients with MSSA bacteremia. Patients who died within 90 days after S. aureus infection was identified were significantly older (P<.01) and more likely to have severe sepsis (P<.01) and pneumonia (P=.01), compared with patients who survived. After adjusting for age as a confounder, comorbidities, and pneumonia as an effect modifier, S. aureus infection-related mortality remained significantly higher in patients with MRSA infection than in those with MSSA infection, among those without pneumonia (hazard ratio, 1.8 [95% confidence interval, 1.2-3.0]); P<.01.

CONCLUSIONS:

The results of this study suggest that patients with MRSA infections other than pneumonia have a higher mortality risk than patients with MSSA infections other than pneumonia, independent of the severity of patients' underlying illnesses.

PMID:
17326017
DOI:
10.1086/512627
[Indexed for MEDLINE]

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