Search

Mortality related to methicillin-resistant Staphylococcus aureus ( MRSA) bloodstream infection ( BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA- BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs ( V- MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex ( CC)5 and carried SCCmec IV and agr2. Microdilution V- MIC50 and V- MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years ( HR 1.88), previous fatal disease ( HR 2.16), Pitt score >1 ( HR 3.45), high-risk source ( HR 1.85) and inappropriate initial treatment ( HR 1.39) as independent predictive factors for mortality. CC5 and CC22 ( HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it. [ABSTRACT FROM AUTHOR]

Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) strains are no longer limited to acute-care hospitals but have now spread to other healthcare settings such as long-term-care facilities (LTCFs), in most of which they are endemic. In Europe, few studies have addressed the MRSA situation in LTCFs. A cross-sectional study to determine MRSA prevalence and factors associated with S. aureus carriage in community LTCF residents is reported here. Nasal and decubitus ulcer cultures were performed for residents of nine community LTCFs. Residents were classified as MRSA carriers, methicillin-susceptible S. aureus carriers and non-carriers. Overall, 1377 nasal swabs and 82 decubitus ulcer cultures were performed. MRSA was isolated from 15.5% and 59.0% of the former and latter, respectively. The prevalence of MRSA colonization was 16.8% (95% CI  14.9–18.8), varying from 6.7% to 35.8% (p <0.001) among LTCFs. Several independent variables were related to MRSA colonization. It is noteworthy that residents in an LTCF with fewer than 150 beds had at least a two-fold higher probability of being MRSA carriers. Modifiable factors were medical devices, decubitus ulcers and previous antibiotic treatment. An age of 85 years or older, a Charlson index ≥2 and transfer from an acute-care facility were non-modifiable factors also related to MRSA colonization. A high MRSA prevalence among residents in community LTCFs in Spain, with great variability among facilities, was found. The factors identified as being associated with MRSA colonization could be prevented by the implementation of several measures. Control strategies need to be coordinated between LTCFs and acute-care hospitals. [ABSTRACT FROM AUTHOR]