Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: Results from the EPIC II study

Hkan Hanberger, Sten Walther, Marc Leone, Philip S. Barie, Jordi Rello, Jeffrey Lipman, John C. Marshall, Antonio R Anzueto, Yasser Sakr, Peter Pickkers, Peter Felleiter, Milo Engoren, Jean Louis Vincent

Research output: Contribution to journalArticle

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Abstract

Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P < 0.01) and corresponding hospital mortality rates were 36.4% and 27.0% (P < 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P = 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.

Original languageEnglish (US)
Pages (from-to)331-335
Number of pages5
JournalInternational Journal of Antimicrobial Agents
Volume38
Issue number4
DOIs
StatePublished - Oct 2011

Fingerprint

Methicillin
Intensive Care Units
Staphylococcus aureus
Mortality
Infection
Hospital Mortality
Odds Ratio
Confidence Intervals
Hemofiltration
Artificial Respiration
Critical Illness
Chronic Kidney Failure
Renal Dialysis
Multivariate Analysis

Keywords

  • Antimicrobial resistance
  • Critically ill
  • Mortality
  • Sepsis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit : Results from the EPIC II study. / Hanberger, Hkan; Walther, Sten; Leone, Marc; Barie, Philip S.; Rello, Jordi; Lipman, Jeffrey; Marshall, John C.; Anzueto, Antonio R; Sakr, Yasser; Pickkers, Peter; Felleiter, Peter; Engoren, Milo; Vincent, Jean Louis.

In: International Journal of Antimicrobial Agents, Vol. 38, No. 4, 10.2011, p. 331-335.

Research output: Contribution to journalArticle

Hanberger, H, Walther, S, Leone, M, Barie, PS, Rello, J, Lipman, J, Marshall, JC, Anzueto, AR, Sakr, Y, Pickkers, P, Felleiter, P, Engoren, M & Vincent, JL 2011, 'Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: Results from the EPIC II study', International Journal of Antimicrobial Agents, vol. 38, no. 4, pp. 331-335. https://doi.org/10.1016/j.ijantimicag.2011.05.013
Hanberger, Hkan ; Walther, Sten ; Leone, Marc ; Barie, Philip S. ; Rello, Jordi ; Lipman, Jeffrey ; Marshall, John C. ; Anzueto, Antonio R ; Sakr, Yasser ; Pickkers, Peter ; Felleiter, Peter ; Engoren, Milo ; Vincent, Jean Louis. / Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit : Results from the EPIC II study. In: International Journal of Antimicrobial Agents. 2011 ; Vol. 38, No. 4. pp. 331-335.
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abstract = "Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95{\%} confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51{\%}) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1{\%} and 20.5{\%}, respectively (P < 0.01) and corresponding hospital mortality rates were 36.4{\%} and 27.0{\%} (P < 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95{\%} CI 1.03-2.06) (P = 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50{\%} higher likelihood of hospital death compared with MSSA infection.",
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