Impact of USA300 Methicillin-Resistant Staphylococcus aureus on Clinical Outcomes of Patients With Pneumonia or Central Line-Associated Bloodstream Infections
| Autor: | Rachel J. Gorwitz, Ghinwa Dumyati, Fernanda C. Lessa, Kenneth A. Gershman, Joelle Nadle, Scott K. Fridkin, William Schaffner, Yi Mu, Aaron S. DeVries, Gregory E. Fosheim, Susan M. Ray, Sandra N. Bulens |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Methicillin-Resistant Staphylococcus aureus Microbiology (medical) medicine.medical_specialty Adolescent Population Bacteremia medicine.disease_cause law.invention Young Adult law Internal medicine Pneumonia Staphylococcal medicine Humans Child education Survival analysis Aged Aged 80 and over Cross Infection education.field_of_study business.industry Incidence Incidence (epidemiology) Infant Newborn Infant Odds ratio Length of Stay Middle Aged biochemical phenomena metabolism and nutrition bacterial infections and mycoses medicine.disease Survival Analysis Methicillin-resistant Staphylococcus aureus Intensive care unit Community-Acquired Infections Pneumonia Treatment Outcome Infectious Diseases Staphylococcus aureus Catheter-Related Infections Child Preschool business |
| Zdroj: | Clinical Infectious Diseases. 55:232-241 |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background: The USA300 methicillin-resistant Staphylococcus aureus (MRSA) strain, which initially emerged as a cause of community-associated infections, has recently become an important pathogen in healthcare-associated infections (HAIs). However, its impact on patient outcomes has not been well studied. We evaluated patients with invasive MRSA infections to assess differences in outcomes between infections caused by USA100 and those caused by USA300. Methods: Population-based data for invasive MRSA infections were used to identify 2 cohorts: (1) nondialysis patients with central line-associated bloodstream infections (CLABSIs) and (2) patients with community-onset pneumonia (PNEUMO) during 2005-2007 from 6 US metropolitan areas. Medical records of patients with confirmed MRSA USA100 or USA300 infection were reviewed. Logistic regression and, when appropriate, survival analysis was performed to evaluate mortality, early and late complications, and length of stay. Results: A total of 236 and 100 patients were included in the CLABSI and PNEUMO cohorts, respectively. USA300 was the only independent predictor of early complications for PNEUMO patients (odds ratio [OR], 2.6; P = .02). Independent predictors of CLABSI late complications included intensive care unit (ICU) admission before MRSA culture (adjusted OR [AOR], 2.1; P= .01) and Charlson comorbidity index (AOR, 2.6; P = .003), but not strain type. PNEUMO patients were significantly more likely to die if they were older (P = .02), black (P < .001), or infected with USA100 strain (P = .02), whereas those with CLABSI were more likely to die if they were older (P < .001), had comorbidities (P < .001), or had an ICU admission before MRSA culture (P = .001). Conclusions: USA300 was associated with early complications in PNEUMO patients. However, it was not associated with mortality for either PNEUMO or CLABSI patients. Concerns regarding higher mortality from HAIs caused by USA300 may not be warranted. |
| Databáze: | OpenAIRE |
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