Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections.

Autor: Zilberberg MD; EviMed Research Group, LLC, Goshen, MA, USA. Evimedgroup@gmail.com, Chaudhari P, Nathanson BH, Campbell RS, Emons MF, Fiske S, Hays HD, Shorr AF
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2012 Jul 11; Vol. 12, pp. 154. Date of Electronic Publication: 2012 Jul 11.
DOI: 10.1186/1471-2334-12-154
Abstrakt: Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of complicated skin and skin structure infections (cSSSI). Patients with MRSA require different empiric treatment than those with non-MRSA infections, yet no accurate tools exist to aid in stratifying the risk for a MRSA cSSSI. We sought to develop a simple bedside decision rule to tailor empiric coverage more accurately.
Methods: We conducted a large multicenter (N=62 hospitals) retrospective cohort study in a US-based database between April 2005 and March 2009. All adult initial admissions with ICD-9-CM codes specific to cSSSI were included. Patients admitted with MRSA vs. non-MRSA were compared with regard to baseline demographic, clinical and hospital characteristics. We developed and validated a model to predict the risk of MRSA, and compared its performance via sensitivity, specificity and other classification statistics to the healthcare-associated (HCA) infection risk factors.
Results: Of the 7,183 patients with cSSSI, 2,387 (33.2%) had MRSA. Factors discriminating MRSA from non-MRSA were age, African-American race, no evidence of diabetes mellitus, cancer or renal dysfunction, and prior history of cardiac dysrhythmia. The score ranging from 0 to 8 points exhibited a consistent dose-response relationship. A MRSA score of 5 or higher was superior to the HCA classification in all characteristics, while that of 4 or higher was superior on all metrics except specificity.
Conclusions: MRSA is present in 1/3 of all hospitalized cSSSI. A simple bedside risk score can help discriminate the risk for MRSA vs. other pathogens with improved accuracy compared to the HCA definition.
Databáze: MEDLINE
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