Staphylococcus aureus bloodstream infections in Latin America: results of a multinational prospective cohort study.

Abstract

BACKGROUND:

Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries.

OBJECTIVES:

To assess the clinical impact of SAB in Latin America.

PATIENTS AND METHODS:

We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model.

RESULTS:

A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P < 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P = 0.616] or in a sensitivity analysis using 30 day all-cause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P = 0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with β-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P = 0.602).

CONCLUSIONS:

MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.

• Authors: Carlos Seas, Coralith Garcia, Mauro J Salles, Jaime Labarca, Carlos Luna, Carlos Alvarez-Moreno, Carlos Mejía-Villatoro, Jeannete Zurita, Manuel Guzmán-Blanco, Eduardo Rodríguez-Noriega, Jinnethe Reyes, Cesar A Arias, Cesar Carcamo, Eduardo Gotuzzo, Latin America Working Group on Bacterial Resistance
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 73 Issue 1 Pg. 212-222 (Jan 01 2018) ISSN: 1460-2091 [Electronic] England
• PMID: 29045648 (Publication Type: Journal Article, Observational Study)
• Copyright: © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Anti-Bacterial Agents
• Vancomycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (drug therapy, epidemiology, microbiology)
• Blood Culture
• Cohort Studies
• Cross Infection (drug therapy, epidemiology, microbiology)
• Female
• Humans
• Latin America (epidemiology)
• Male
• Methicillin-Resistant Staphylococcus aureus (drug effects, isolation & purification)
• Middle Aged
• Prospective Studies
• Staphylococcal Infections (drug therapy, epidemiology, mortality)
• Vancomycin (therapeutic use)