Infect Chemother.  2013 Jun;45(2):202-210. 10.3947/ic.2013.45.2.202.

Impact of Methicillin-Resistance on Mortality in Children and Neonates with Staphylococcus aureus Bacteremia: A Meta-analysis

• Park DA
• Lee SM
• Peck KR
• Joo EJ
• Oh EG

• KMID: 2285001
• DOI: http://doi.org/10.3947/ic.2013.45.2.202

Abstract

BACKGROUND
Staphylococcus aureus bacteremia (SAB) is the Staphylococcal infections in blood, one of the most common and fatal bacterial infectious diseases worldwide in adults as well as children or neonates. Recently, some studies have yielded inconsistent findings about the association between methicillin-resistance and mortality in patients with SAB. We performed a meta-analysis to assess the impact of methicillin-resistance on mortality in children or neonates with S. aureus bacteremia.
MATERIALS AND METHODS
We searched using electronic databases such as Ovid-Medline, EMBASE-Medline, and Cochrane Library, as well as five local databases for published studies during the period of 1 January 2000 to 15 September 2011. Two reviewers independently selected articles in accordance with predetermined criteria and extracted prespecified data based on standardized forms. All cohort studies, which compared in-hospital mortality or SAB-related mortality in children and neonates with methicillin-resistant S. aureus (MRSA) infection to those with methicillin-susceptible S. aureus (MSSA), were included. We conducted meta-analysis using the fixed-effect model to obtain pooled estimates of effect.
RESULTS
Of 2,841 screened studies, seven cohort studies were finally selected for analysis. In children or neonates, MRSA bacteremia was associated with a higher mortality compared with MSSA bacteremia (pooled odds ratio [OR] 2.33, P = 0.0008, 95% confidence interval [CI] 1.42 to 3.82, I2 = 0%). Four studies reported SAB-related mortality, the pooled OR of these studies was 2.03 (P = 0.29, 95% CI 0.55 to 7.53, I2 = 0%). A significant increase in mortality associated with methicillin resistance was found in the subgroup analyses of the studies with only neonates (OR: 2.66, 95% CI: 1.46 to 4.85, P = 0.001), prospectively design ones (OR: 3.20, 95% CI: 1.66 to 6.15, P = 0.0005,), the larger studies (OR: 2.89, 95% CI: 1.62 to 5.16, P = 0.0003) and the higher quality studies (OR: 2.76, 95% CI: 1.50 to 5.06, P = 0.001).
CONCLUSIONS
MRSA bacteremia is associated with increased mortality compared with MSSA bacteremia in children or neonates. Due to limited studies for mortality in children or neonates with SAB, further research is needed to evaluate the impact of methicillin resistance on mortality in those populations.

Keyword

Staphylococcus aureus; Bacteremia; Methicillin Resistance; Mortality; Meta-analysis

MeSH Terms

Adult
Bacteremia
Child
Cohort Studies
Communicable Diseases
Electronics
Electrons
Hospital Mortality
Humans
Infant, Newborn
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Odds Ratio
Staphylococcal Infections
Staphylococcus
Staphylococcus aureus

Figure

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  Figure 1 Study flow diagram.

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  Figure 2 Mortality: MRSA bacteremia versus MSSA bacteremia.

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  Figure 3 Infection-related mortality: MRSA bacteremia versus MSSA bacteremia.

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  Figure 4 Mortality of S. aureus bacteremia analysed by study population.

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