Korean J Intern Med.  2013 Nov;28(6):678-686. 10.3904/kjim.2013.28.6.678.

Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study

• Ok HS
• Lee HS
• Park MJ
• Kim KH
• Kim BK
• Wi YM
• Kim JM

• KMID: 1780128
• DOI: http://doi.org/10.3904/kjim.2013.28.6.678

Abstract

BACKGROUND/AIMS
The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia.
METHODS
All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (> or = 7 days) and nonpersistent MRSA bacteremia (< or = 3 days).
RESULTS
Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029).
CONCLUSIONS
High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.

Keyword

Methicillin-resistant Staphylococcus aureus; Mortality; Persistent

MeSH Terms

Academic Medical Centers
Aged
Anti-Bacterial Agents/therapeutic use
Catheter-Related Infections/diagnosis/drug therapy/*microbiology/mortality
Catheters, Indwelling/*adverse effects
Comorbidity
Device Removal
Female
Hospital Bed Capacity
Humans
Logistic Models
Male
Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification
Middle Aged
Multivariate Analysis
Neoplasms/microbiology/mortality
Odds Ratio
Prospective Studies
Republic of Korea
Risk Factors
Staphylococcal Infections/diagnosis/drug therapy/*microbiology/mortality
Time Factors
Treatment Outcome
Anti-Bacterial Agents