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. 2021 Nov;49(11):3000605211058872.
doi: 10.1177/03000605211058872.

Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia

Tomonori Aratani  1 , Hitoshi Tsukamoto  1   2 , Takashi Higashi  1 , Takaaki Kodawara  1 , Ryoichi Yano  3 , Yukio Hida  2   4 , Hiromichi Iwasaki  2 , Nobuyuki Goto  1
Affiliations

Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia

Tomonori Aratani et al. J Int Med Res. 2021 Nov.

Abstract

Objective: Methicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB.

Methods: We conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis.

Results: Among 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome.

Conclusions: Methicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.

Keywords: Appropriate antibiotics; Methicillin-resistant Staphylococcus aureus; Staphylococcus aureus; bacteremia; methicillin resistance; mortality.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Duration of hospital stay versus bacteremia onset. Distribution of patients with MSSA (gray bars) and MRSA (black bars) bacteremia according to length of hospital stay (number of days post-admittance) at the time of bacteremia onset. The duration of pre-SAB hospital stay in patients with MRSA bacteremia was significantly longer than for those with MSSA bacteremia (mean ± standard deviation 19.9 ± 21.4 vs. 48.5 ± 43.6; median [interquartile range] 12 [6–27] vs. 33 [17–65]; P < 0.001). MSSA, methicillin-susceptible Staphylococcus aureus; MRSA, methicillin-resistant S. aureus; SAB, S. aureus bacteremia.
See this image and copyright information in PMC

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