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Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012

Published online by Cambridge University Press:  19 January 2016

Andrew E. Simor ,
Linda Pelude ,
George Golding ,
Rachel Fernandes ,
Elizabeth Bryce ,
Charles Frenette ,
Denise Gravel ,
Kevin Katz ,
Allison McGeer  and
Michael R. Mulvey
...Show all authors
Andrew E. Simor*
Affiliation:
Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario
Linda Pelude
Affiliation:
Public Health Agency of Canada, Ottawa, Ontario
George Golding
Affiliation:
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
Rachel Fernandes
Affiliation:
Public Health Agency of Canada, Ottawa, Ontario
Elizabeth Bryce
Affiliation:
Vancouver Coastal Health, Vancouver, British Columbia
Charles Frenette
Affiliation:
McGill University Health Centre, Montreal, Quebec
Denise Gravel
Affiliation:
Public Health Agency of Canada, Ottawa, Ontario
Kevin Katz
Affiliation:
North York General Hospital, Toronto, Ontario
Allison McGeer
Affiliation:
Mount Sinai Hospital, Toronto, Ontario
Michael R. Mulvey
Affiliation:
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
Stephanie Smith
Affiliation:
University of Alberta, Edmonton, Alberta
Karl Weiss
Affiliation:
Maisonneuve-Rosemont Hospital, Montreal, Quebec.
*
Address correspondence to Andrew Simor, MD, Department of Microbiology, Sunnybrook Health Sciences Centre, B103-2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (andrew.simor@sunnybrook.ca).
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Abstract

BACKGROUND

Bloodstream infection (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with considerable morbidity and mortality.

OBJECTIVE

To determine the incidence of MRSA BSI in Canadian hospitals and to identify variables associated with increased mortality.

METHODS

Prospective surveillance for MRSA BSI conducted in 53 Canadian hospitals from January 1, 2008, through December 31, 2012. Thirty-day all-cause mortality was determined, and logistic regression analysis was used to identify variables associated with mortality.

RESULTS

A total of 1,753 patients with MRSA BSI were identified (incidence, 0.45 per 1,000 admissions). The most common sites presumed to be the source of infection were skin/soft tissue (26.6%) and an intravascular catheter (22.0%). The most common spa types causing MRSA BSI were t002 (USA100/800; 55%) and t008 (USA300; 29%). Thirty-day all-cause mortality was 23.8%. Mortality was associated with increasing age (odds ratio, 1.03 per year [95% CI, 1.02–1.04]), the presence of pleuropulmonary infection (2.3 [1.4–3.7]), transfer to an intensive care unit (3.2 [2.1–5.0]), and failure to receive appropriate antimicrobial therapy within 24 hours of MRSA identification (3.2 [2.1–5.0]); a skin/soft-tissue source of BSI was associated with decreased mortality (0.5 [0.3–0.9]). MRSA genotype and reduced susceptibility to vancomycin were not associated with risk of death.

CONCLUSIONS

This study provides additional insight into the relative impact of various host and microbial factors associated with mortality in patients with MRSA BSI. The results emphasize the importance of ensuring timely receipt of appropriate antimicrobial agents to reduce the risk of an adverse outcome.

Infect. Control Hosp. Epidemiol. 2016;37(4):390–397

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 4 , April 2016 , pp. 390 - 397
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

A list of members of the Canadian Nosocomial Infection Surveillance Program who participated in the surveillance for methicillin-resistant Staphylococcus aureus bloodstream infection appears at the end of the text.

Presented in part: IDWeek 2013; San Francisco, CA; October 3, 2013 (Abstract 383).

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