INTRODUCTION

METHODS
Study population and study design
Data collection and definitions
Microbiological methods
Statistical analysis

RESULTS
Study population
Risk factors associated with early mortality of patients with MRSAB
Table 1.
Variable | Early mortality (n = 25) | Late mortality (n = 50) | Survival (n= 310) | p valuea | p valueb | p valuec |
---|---|---|---|---|---|---|
Demographic | ||||||
Age ≥ 65 year-old | 15 (60.0) | 27 (54.0) | 157 (50.6) | 0.81 | 0.41 | 0.76 |
Male | 15 (60.0) | 34 (68.0) | 199 (64.2) | 0.61 | 0.67 | 0.64 |
Site of MRSA acquisition | ||||||
Hospital-acquired | 17 (68.0) | 42 (84.0) | 228 (73.5) | 0.14 | 0.64 | 0.16 |
Healthcare-associated | 7 (28.0) | 7 (14.0) | 68 (21.9) | 0.21 | 0.46 | 0.26 |
Community-acquired | 1 (4.0) | 1 (2.0) | 14 (4.5) | 1.00 | 1.00 | 0.70 |
Length of hospital stay before MRSA detection | ||||||
< 72 hours | 9 (36.0) | 9 (18.0) | 92 (29.7) | 0.10 | 0.50 | 0.09 |
3–7 days | 2 (8.0) | 4 (8.0) | 27 (8.7) | 1.00 | 1.00 | 1.00 |
8–28 days | 10 (40.0) | 25 (50.0) | 122 (39.4) | 0.47 | 1.00 | 0.17 |
> 28 days | 4 (16.0) | 12 (24.0) | 69 (22.3) | 0.56 | 0.62 | 0.86 |
Underlying disease | ||||||
Solid tumor | 14 (56.0) | 25 (50.0) | 115 (37.1) | 0.81 | 0.09 | 0.09 |
Hematologic malignancy | 1 (4.0) | 7 (14.0) | 19 (6.1) | 0.26 | 1.00 | 0.07 |
ESRD | 0 | 3 (6.0) | 39 (12.6) | 0.55 | 0.10 | 0.24 |
Liver cirrhosis | 8 (32.0) | 8 (16.0) | 34 (11.0) | 0.14 | 0.01 | 0.34 |
Cardiovascular disease | 5 (20.0) | 10 (20.0) | 55 (17.7) | 1.00 | 0.79 | 0.69 |
Severity of comorbidity | ||||||
Charlson comorbidity score ≥ 5 | 12 (48.0) | 22 (44.0) | 68 (21.9) | 0.81 | 0.01 | < 0.001 |
McCabe and Jackson classification | ||||||
Rapidly or ultimately fatal | 20 (80.0) | 35 (70.0) | 97 (31.3) | 0.42 | < 0.001 | < 0.001 |
Site of infection | ||||||
Catheter-related blood stream infection | 9 (36.0) | 24 (48.0) | 141 (45.5) | 0.46 | 0.41 | 0.76 |
Arteriovenous fistula infection | 0 | 0 | 6 (1.9) | NA | 1.00 | 1.00 |
Pneumonia | 5 (20.0) | 5 (10.0) | 30 (9,7) | 0.29 | 0.16 | 1.00 |
Skin and soft tissue infection | 0 | 3 (6.0) | 12 (3.9) | 0.55 | 0.61 | 0.45 |
Surgical site infection | 2 (8.0) | 2 (4.0) | 32 (10.3) | 0.60 | 1.00 | 0.20 |
Bone and joint infection | 0 | 1 (2.0) | 18 (5.8) | 1.00 | 0.38 | 0.49 |
Urinary tract infection | 0 | 0 | 3 (1.0) | NA | 1.00 | 1.00 |
Infective endocarditis | 1 (4.0) | 3 (6.0) | 5 (1.6) | 1.00 | 0.37 | 0.09 |
Unknown | 8 (32.0) | 24 (48.0) | 141 (45.5) | 0.46 | 0.41 | 0.05 |
Severity of illness | ||||||
Severe sepsis or septic shock | 20 (80.0) | 27 (54.0) | 77 (24.8) | 0.04 | < 0.001 | < 0.001 |
Pitt bacteremia score ≥ 3 | 17 (68.0) | 27 (54.0) | 73 (23.5) | 0.004 | < 0.001 | < 0.001 |
Eradicable foci | 10 (43.6) | 28 (59.6) | 194 (64.9) | 0.31 | 0.046 | 0.51 |
Early removal | 2 (16.7) | 24 (75.0) | 175 (78.1) | 0.001 | < 0.001 | 0.66 |
Anti-MRSA therapy | ||||||
On day 0 | 12 (48.0) | 24 (48.0) | 79 (25.5) | 1.00 | 0.02 | 0.001 |
On day 0 or 1 | 16 (64.0) | 50 (100) | 308 (99.4) | < 0.001 | < 0.001 | 1.00 |
Microbiologic factors | ||||||
Vancomycin MIC by E-test ≥ 1.5 μg/mL | 13 (52.0) | 35 (70.0) | 216 (69.7) | 0.14 | 0.08 | 1.00 |
hVISA phenotype | 5 (20.0) | 14 (28.0) | 94 (30.3) | 0.58 | 0.19 | 0.87 |
ST72-SCCmecIV-agrI strain | 8 (32.0) | 4 (8.0) | 74 (23.9) | 0.02 | 0.34 | 0.009 |
agr dysfunction | 18 (72.0) | 37 (74.0) | 211 (68.1) | 1.00 | 1.00 | 0.30 |
Virulence genes | ||||||
sdrC | 17 (68.0) | 43 (86.0) | 261 (84.2) | 0.12 | 0.05 | 0.84 |
sec | 16 (64.0) | 37 (74.0) | 204 (65.8) | 0.43 | 0.83 | 0.33 |
sel | 16 (64.0) | 44 (88.0) | 232 (74.8) | 0.03 | 0.24 | 0.047 |
TSST-1 | 14 (56.0) | 40 (80.0) | 207 (66.8) | 0.05 | 0.28 | 0.07 |
Values are presented as number (%).
MRSA, methicillin-resistant Staphylococcus aureus; ESRD, end-stage renal disease; NA, not applicable; MIC, microbacterial inhibitory concentration; hVISA, heterogeneous vancomycin-intermediate Staphylococcus aureus; ST, sequence type; SCC, staphylococcal cassette chromosome; TSST-1, toxic shock syndrome toxin 1.
Table 2.
Variable |
Early mortality vs. late mortality |
Early mortality vs. survival |
Late mortality vs. survival |
|||
---|---|---|---|---|---|---|
Univariate analysis, OR (95% CI) | Multivariate analysis, aOR (95% CI) | Univariate analysis, OR (95% CI) | Multivariate analysis, aOR (95% CI) | Univariate analysis, OR (95% CI) | Multivariate analysis, aOR (95% CI) | |
Comorbidity | ||||||
Liver cirrhosis | - | - | 2.92 (1.52–5.61) | 3.79 (1.38–10.37)a | - | - |
McCabe and Jackson classification | ||||||
Rapidly or ultimately fatal | - | - | - | - | 2.24 (1.75–2.86) | 4.61 (2.37–9.00)a |
Severity of illness | ||||||
Severe sepsis or septic shock | 1.48 (1.07–2.05) | 4.49 (1.28–15.75)a | 3.22 (2.45–4.24) | 10.98 (3.82–31.52)a | 2.17 (1.58–3.00) | 2.95 (1.54–5.63)a |
Treatment | ||||||
Anti-MRSA therapy on D0 | - | - | 1.88 (1.20–2.96) | 1.41 (0.57–3.50) | - | - |
Microbiologic factors | ||||||
ST72-SCCmecIV-agrI strain | 3.20 (1.17–8.78) | 3.14 (0.41–23.86) | - | - | 1.18 (1.05–1.32) | 1.75 (0.20–1.69) |
sel | 0.73 (0.53–0.99) | 0.43 (0.07–2.77) | - | - | 0.48 (0.22–1.04) | 0.58 (0.20–1.69) |
Risk factors associated with severe sepsis or septic shock
Table 3.
Values are presented as number (%).
MRSA, methicillin-resistant Staphylococcus aureus; OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; ESRD, endstage renal disease; NA, not applicable; MIC, microbacterial inhibitory concentration; hVISA, heterogeneous vancomycin-intermediate Staphylococcus aureus; ST, sequence type; SCC, staphylococcal cassette chromosome.

DISCUSSION

KEY MESSAGE
