Increased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: results from the EPIC II study.

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 13796 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 13796 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.

Hanberger H ，Walther S ，Leone M ，Barie PS ，Rello J ，Lipman J ，Marshall JC ，Anzueto A ，Sakr Y ，Pickkers P ，Felleiter P ，Engoren M ，Vincent JL ，EPIC II Group of Investigators ... -  《-》

Risk factors for ICU-acquired methicillin-resistant Staphylococcus aureus infections.

Oztoprak N ，Cevik MA ，Akinci E ，Korkmaz M ，Erbay A ，Eren SS ，Balaban N ，Bodur H ... -  《AMERICAN JOURNAL OF INFECTION CONTROL》

Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit.

Ibelings MM ，Bruining HA 《-》

Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus.

Wang JL ，Chen SY ，Wang JT ，Wu GH ，Chiang WC ，Hsueh PR ，Chen YC ，Chang SC ... -  《-》

Nasal carriage of meticillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients.

Lederer SR ，Riedelsdorf G ，Schiffl H 《EUROPEAN JOURNAL OF MEDICAL RESEARCH》