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Meta-Analysis
. 2019 Nov;34(6):1347-1362.
doi: 10.3904/kjim.2017.098. Epub 2018 Jan 20.

Reevaluation of the impact of methicillin-resistance on outcomes in patients with Staphylococcus aureus bacteremia and endocarditis

Eun-Jeong Joo  1 , Dong Ah Park  2 , Cheol-In Kang  3 , Doo Ryeon Chung  3 , Jae-Hoon Song  3 , Sang Moo Lee  2 , Kyong Ran Peck  3
Affiliations
Meta-Analysis

Reevaluation of the impact of methicillin-resistance on outcomes in patients with Staphylococcus aureus bacteremia and endocarditis

Eun-Jeong Joo et al. Korean J Intern Med. 2019 Nov.

Abstract

Background/aims: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and has recently emerged in the community. The impact of methicillin-resistance on mortality and medical costs for patients with S. aureus bacteremia (SAB) requires reevaluation.

Methods: We searched studies with SAB or endocarditis using electronic databases including Ovid-Medline, Embase-Medline, and Cochrane Library, as well as five local databases for published studies during the period January 2000 to September 2011.

Results: A total of 2,841 studies were identified, 62 of which involved 17,563 adult subjects and were selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with methicillin-susceptible S. aureus (MSSA), was evidenced by an odds ratio (OR) of 1.95 (95% confidence interval [CI], 1.73 to 2.21; p < 0.01). In 13 endocarditis studies, MRSA increased the risk of mortality, with an OR of 2.65 (95% CI, 1.46 to 4.80). When three studies, which compared mortality rates between CA-MRSA and CA-MSSA, were combined, the risk of methicillin-resistance increased 3.23-fold compared to MSSA (95% CI, 1.25 to 8.34). The length of hospital stay in the MRSA group was 10 days longer than that in the MSSA group (95% CI, 3.36 to 16.70). Of six studies that reported medical costs, two were included in the analysis, which estimated medical costs to be $9,954.58 (95% CI, 8,951.99 to 10,957.17).

Conclusion: MRSA is still associated with increased mortality, longer hospital stays and medical costs, compared with MSSA in SAB in studies published since the year 2000.

Keywords: Bacteremia; Endocarditis; Methicillin resistance; Mortality; Staphylococcus aureus.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flow diagram detailing reviewed articles and exclusion. DB, database.
Figure 2.
Figure 2.
Forest plot summary of the results of 60 studies which reported all-cause mortality. MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible S. aureus; CI, confidence interval.
Figure 3.
Figure 3.
Forest plot summary of results of eight which reported all-cause mortality in Staphylococcus aureus bacteremia and endocarditis in the Korean population. MRSA, methicillin-resistant S. aureus; MSSA, methicillin-susceptible S. aureus; CI, confidence interval.
Figure 4.
Figure 4.
Forest plot summary of results of three studies which reported mortality rates between community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) and CA-methicillin-susceptible S. aureus (MSSA). CI, confidence interval.
See this image and copyright information in PMC

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