Abstract
ABSTRACTPrevious studies have separately emphasized the importance of host, pathogen, and treatment characteristics in determining short-term or in-hospital mortality rates for patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections. Less is known about the relative importance of these factors and their interactions in determining short-, medium-, and long-term mortality rates. This is an observational cohort study in which data for all patients admitted to the University of New Mexico (UNM) Health Sciences Center (HSC) between July 2002 and August 2013 with MRSA-positive blood cultures were recorded. We collected patients' demographics and treatment data, as well as data on genetic markers of the MRSA isolates. Outcomes of interest were determinants of short-term (within 30 days), medium-term (30 to 90 days), and long-term (>90 days) mortality rates. This study included 273 patients with MRSA bacteremia. Short-, medium-, and long-term mortality rates were 18.7%, 26.4%, and 48%, respectively. Thirty-day mortality rates were influenced by host variables and host-pathogen interaction characteristics. Pitt bacteremia scores, malignancy, and health care exposure contributed to 30- to 90-day mortality rates, while treatment duration of >4 weeks had a protective effect. Age remained a significant risk factor for death at >90 days, while admission leukocytosis was protective. Infection represented the most frequent cause of death for all three time frames; rates varied from 72.6% in the first 30 days and 60% for 30 to 90 days to 35.7% for >90 days (P = 0.003). Host characteristics affect short-, medium-, and long-term mortality rates for MRSA bloodstream infections more than do pathogen genetic markers and treatment factors.
Highlights
Previous studies have separately emphasized the importance of host, pathogen, and treatment characteristics in determining short-term or in-hospital mortality rates for patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) carry mortality rates twice as high, higher in-hospital complication rates, and greater health care costs, compared with bloodstream infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) [3, 4]
Vancomycin represented the empirical drug of choice (97.1%), and appropriate antibiotics were administered in 86.4% of the cases
Summary
Previous studies have separately emphasized the importance of host, pathogen, and treatment characteristics in determining short-term or in-hospital mortality rates for patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections. Host characteristics affect short-, medium-, and long-term mortality rates for MRSA bloodstream infections more than do pathogen genetic markers and treatment factors. To answer this question, we set out to define the interplay between host, pathogen, and antimicrobial treatment when determining 30-day in-hospital mortality rates and medium- and long-term mortality rates. We set out to define the interplay between host, pathogen, and antimicrobial treatment when determining 30-day in-hospital mortality rates and medium- and long-term mortality rates In this way, the most relevant interventions can be developed and can be undertaken at specific times during the course of the bacteremia to yield the greatest impact on mortality rates
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