Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia Mortalidad en pacientes gravemente enfermos con bacteriemia por Staphylococcus aureus resistente a la meticilina: un estudio multicéntrico de cohortes en Colombia

• Main Authors: Juan S. Castillo, Aura L. Leal, Jorge A. Cortes, Carlos A. Alvarez, Ricardo Sanchez, Giancarlo Buitrago, Liliana I. Barrero, Andrés L. Gonzalez, Daibeth H. Henriquez
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2012
• Subjects: Infecciones bacterianas; Staphylococcus aureus resistente a meticilina; evaluación de resultado (atención de salud); factores de riesgo; mortalidad; Colombia; Bacterial infections; methicillin-resistant Staphylococcus aureus; outcome assessment (health care); risk factors; mortality; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/2f7dcb00930e4ed7989748605ed72797

OBJECTIVE: To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. METHODS: A multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. RESULTS: A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. CONCLUSIONS: Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory. OBJETIVO: Evaluar los factores de riesgo asociados con la aparición de bacteriemia por Staphylococcus aureus resistente a la meticilina (MRSA), su pronóstico y los factores determinantes de la mortalidad en pacientes gravemente enfermos en Colombia. MÉTODOS: Estudio retrospectivo multicéntrico de cohortes realizado en el ...