Prevalence, predictors, and mortality of bloodstream infections due to methicillin-resistant Staphylococcus aureus in patients with malignancy: systemic review and meta-analysis

Zhouqi Li,Ying Dong,Hemu Zhuang,Hui Wang,Guannan Wang

doi:10.1186/s12879-021-05763-y

Abstract

BackgroundCancer patients are more likely to develop and die of bloodstream infection (BSI) than noncancer patients. Methicillin-resistant Staphylococcus aureus (MRSA), which is associated with immense mortality and economic burden worldwide, is not covered by the recommended initial antibiotic therapy for cancer patients with BSI. This systemic review was performed to estimate the global methicillin-resistant Staphylococcus aureus (MRSA) prevalence among bacteremia in patients with malignancy, and further study the predictors and mortality of cancer patients with MRSA bacteremia.MethodsThe PubMed and EMBASE databases were searched for studies published from Jan. 2000 to Mar. 2020 that provided primary data on the prevalence, predictors, or mortality of MRSA bacteremia in cancer patients. A random-effects model meta-analysis was performed to estimate the pooled prevalence of MRSA with 95% confidence intervals (95% CIs).ResultsThe pooled prevalence of MRSA was 3% (95% CI 2–5%) among all bloodstream infections (BSIs) and 44% (95% CI 32–57%) among S. aureus bacteremia in cancer patients. Based on geographical stratification, the pooled prevalence was 5% in Africa (95% CI 1–14%), 1% in Americas (95% CI 1–2%), 2% in Europe (95% CI 1–4%), 4% in Western Pacific (95% CI 2–7%), 8% in South-east Asia (95% CI 4–14%) and 0% in Eastern Mediterranean (95% CI 0–3%). No significant temporal change in MRSA rates was detected in this analysis (R2 = 0.06; P = 0.24). Predictors for MRSA BSIs among cancer patients were identified by comparison with their methicillin-susceptible counterparts, and they were mainly related to healthcare-associated infections and immunosuppression. Finally, the 60-day mortality in adult cancer patients with MRSA BSIs was reported to be 12%, and the 6-month overall mortality was 43.2%, with community-onset infection, secondary BSI, and vancomycin MIC≥2 g/mL being the risk factors for mortality.ConclusionsAlthough the prevalence of MRSA BSIs among cancer patients is relatively low, it did not decline over time as MRSA BSIs in the general hospital population and the high mortality rate was related to MRSA BSIs in patients with malignancy.

Highlights

Cancer patients are more likely to develop and die of bloodstream infection (BSI) than noncancer patients
Conclusions: the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) BSIs among cancer patients is relatively low, it did not decline over time as MRSA BSIs in the general hospital population and the high mortality rate was related to MRSA BSIs in patients with malignancy
Hospital-onset MRSA bacteremia rates substantially reduced between 2005 and 2012, and the rate of decrease has slowed since 2012 in the general population of the US [57]. This decline was not detected in MRSA-BSIs among patients with malignancy, which might be explained by two possible reasons: firstly, with the emergence of colony-stimulating factors, Immunomodulatory drugs, etc., cancer patients are still exposed to cytotoxic chemotherapy, broad-spectrum antibiotics, and undergo frequent invasive procedures, rendering them immunosuppressed and susceptible to MRSA; secondly, the rate of community-associated MRSA (CA-MRSA) remains stable, and there is a surge of MRSA in some regions [16, 57]

Summary

Introduction

Cancer patients are more likely to develop and die of bloodstream infection (BSI) than noncancer patients. Methicillin-resistant Staphylococcus aureus (MRSA), which is associated with immense mortality and economic burden worldwide, is not covered by the recommended initial antibiotic therapy for cancer patients with BSI. Cancer patients are highly susceptible to bloodstream infection (BSI) due to frequent hospital admissions, cytotoxic chemotherapy, use of invasive procedures, and exposure to broad-spectrum antibiotics [1, 2]. They witnessed a more significant increase in the incidence of BSI, and a higher mortality rate than noncancer patients in recent years [3], with prevalence ranging from 11 to 38% and the mortality rate around 40% [4]. The presence of SAB indicated an increased risk of death in cancer patients [13, 14]

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