Comparison of Outcomes among Adult Patients with Nosocomial Bacteremia Caused by Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus: A Retrospective Cohort StudyReportar como inadecuado




Comparison of Outcomes among Adult Patients with Nosocomial Bacteremia Caused by Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus: A Retrospective Cohort Study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Several studies have shown that patients with bacteremia caused by methicillin-resistant Staphylococcus aureus MRSA have worse outcomes than those with bacteremia caused by methicillin-susceptible S. aureus MSSA. However, only a limited number of studies have stratified the MRSA isolates into healthcare-associated HA- and community-associated CA- MRSA strains in such a comparison. This three-year retrospective cohort study, enrolling adult patients with nosocomial S. aureus bacteremia SAB, was designed to investigate whether CA-MRSA and-or HA-MRSA strains were associated with different outcomes in comparison to MSSA in such a setting. The drug susceptibilities and staphylococcal cassette chromosome mec SCCmec types were determined for all of the causative isolates available. The MRSA bacteremia was further categorized into those caused by CA-MRSA strains CA-MRSA-S bacteremia when the causative isolates carried the type IV or V SCCmec element, those caused by HA-MRSA strains HA-MRSA-S bacteremia when the isolates carried the type I, II, or III SCCmec element, or unclassified MRSA bacteremia when the isolates were not available. The relevant demographic, clinical, and laboratory data were collected by reviewing the patients’ charts. The primary outcome was all-cause in-hospital mortality. A total of 353 patients were studied. The overall in-hospital mortality rate was 32.6%, with 23.3% in MSSA, 30.5% in CA-MRSA-S, 47.5% in HA-MRSA-S, and 35.3% in unclassified MRSA bacteremia, respectively. The multivariate analysis showed that HA-MRSA-S, but not CA-MRSA-S, bacteremia was associated with a significantly worse outcome compared with MSSA. The other risk factors independently associated with all-cause in-hospital mortality included the Charlson co-morbidity index, septic shock, thrombocytopenia, and persistent bacteremia. Resistance to linezolid and daptomycin was found among the MRSA isolates. The present study showed that bacteremia caused by HA-MRSA-S, but not CA-MRSA-S, was an independent risk factor for all-cause in-hospital mortality in patients with nosocomial SAB. Continuous monitoring regarding the susceptibilities of MRSA to linezolid and daptomycin is necessary.



Autor: Jann-Tay Wang, Le-Yin Hsu, Tsai-Ling Lauderdale, Wen-Chien Fan, Fu-Der Wang

Fuente: http://plos.srce.hr/



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