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Staphylococcus aureus Bacteremia in Older Adults: Predictors of 7-Day Mortality and Infection With a Methicillin-Resistant Strain

  • Mazen S. Bader (a1) (a2)

Abstract

Objectives.

To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA).

Design.

Retrospective cohort study from January 2003 until December 2004.

Setting.

Two tertiary care, university-affiliated hospitals.

Methods.

One hundred thirty-five hospitalized patients with S. aureus bacteremia were included in the study. All patients who were 60 years or older and had 1 or more blood cultures positive for S. aureus were included in the study. The primary outcome was death 7 days after the onset of S. aureus bacteremia.

Results.

Twenty-one patients (15.6%) died within 7 days after the onset of S. aureus bacteremia. Seventy-four patients (56.1%) had MRSA bacteremia. Multivariate analysis identified 3 independent determinants of 7-day mortality: Charlson WIC score greater than 5 (odds ratio [OR], 3.6 [95% confidence interval {CI}, 1.1-11.2]; P = .03), previous hospitalization in the past 3 months (OR, 5.0 [95% CI, 1.1-25.1]; P = .04), and altered mental status at the onset of S. aureus bacteremia (OR, 13.6 [95% CI, 2.9-64.6]; P = .001). Multivariate analysis identified .previous hospitalization in the past 3 months (OR, 2.6 [95% CI, 1.1-5.9]; P = .02), residence in a long-term care facility (OR, 4.5 [95% CI, 1.7-12.3]; P = .003), and altered mental status at the onset of S. aureus bacteremia (OR, 2.5 [95% CI, 1.5-5.6]; P = .02) to be independently associated with the presence of MRSA.

Conclusions.

The Charlson WIC is significantly associated with increased mortality of S. aureus bacteremia in older adults. Previous hospitalization in the past 3 months, residence in a long-term care facility, and altered mental status should be used as a guidance for empirical vancomycin therapy and application of infection control measures in older adults with suspected S. aureus bacteremia.

Copyright

Corresponding author

Memorial University of Newfoundland Health Sciences Center, Division of Microbiology and Infectious Diseases, 300 Prince Phillip Drive, Office 1J426, St. John's, Newfoundland A1B3V6, Canada (msbaderl@hotmail.com)

References

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1. Mitchell, J. Primary Care Geriatrics. 4th ed. St. Louis, MO: Mosby; 2002:914.
2. Lyytikäinen, O, Ruotsalainen, E, Järvinen, A, Valtonen, V, Ruutu, P. Trends and outcome of nosocomial and community-acquired bloodstream infections due to Staphylococcus aureus in Finland, 1995-2001. Eur J Clin Microbiol Infect Dis 2005; 24:399404.
3. Gavazzi, G, Mallaret, MR, Couturier, P, Iffenecker, A, Franco, A. Bloodstream infection: differences between young-old, old and old-old patients. J Am Geriatr Soc 2002; 50:16671673.
4. McClelland, RS, Fowler, VJ, Sanders, LL, et al. Staphylococcus aureus bacteremia among elderly vs. young adult patients: comparison of clinical features and mortality. Arch Intern Med 1999; 159:12441247.
5. Jensen, LG, Cartsen, H, Wachmann, CH, et al. Treatment and outcome of Staphylococcal aureus bacteremia. Arch Intern Med 2002; 162:2532.
6. Mylotte, JM, Tayara, A. Staphylococcus aureus bacteremia: predictors of 30-day mortality in a large cohort. Clin Infect Dis 2000; 31:11701174.
7. Soriano, A, Martinez, AJ, Mensa, J, et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000; 30:368373.
8. Lesens, O, Methlin, C, Hansmann, Y, et al. Role of comorbidity in mortality related to Staphylococcus aureus bacteremia: a prospective study using the Charlson weighted index of comorbidity. Infect Control Hosp Epidemiol 2003; 24:890896.
9. Kuehnerst, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant Staphylococcus aureus hospitalization, United States. Emerg Infect Dis 2005; 11:868872.
10. Papia, G, Louie, M, Tralla, A, et al. Screening high-risk patients for methicillin-resistant Staphylococcus aureus: is it cost-effective? Infect Control Hosp Epidemiol 1999; 20:473477.
11. Charlson, ME, Pompei, P, Ales, KL, MacKinzie, CR. A new method for classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373383.
12. Le Gall, JR, Lemeshow, S, Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:29572963.
13. Romero-vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1995; 21:14171423.
14. McCabe, WR, Jackson, GG. Gram-negative bacteremia: etiology and ecology. Arch Intern Med 1962; 110:847855.
15. Soufir, L, Timsit, JF, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999; 20:396401.
16. McGregor, JC, Kim, PW, Perencevich, EN, et al. Utility of the Chronic Disease Score and Charlson Comorbidity Index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol 2005; 161:483493.
17. Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:13931398.
18. Warshawsky, B, Hussain, Z, Gregson, DB, et al. Hospital- and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol 2000;21:724727.
19. Morin, CA, Hadler, JL. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. J Infect Dis 2001; 184:10291034.
20. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137:791797.
21. Goetz, A, Posey, K, Fleming, J, et al. Methicillin-resistant Staphylococcus aureus in the community: a hospital-based study. Infect Control Hosp Epidemiol 1999; 20:689691.
22. Fatkenheuer, G, Preuss, M, Salzberger, B, et al. Long-term outcome and quality of care of patients with Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2004; 23:157162.
23. Rezende, NA, Blumberg, HM, Metzger, BS, Larsen, NM, Ray, SM, McGowan, JE. Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 2002; 323:117123.
24. Kim, SH, Park, WB, Lee, KD, et al. Outcome of inappropriate initial antimicrobial treatment in patients with methicillin-resistant Staphylococcus aureus bacteremia. J Antimicrob Chemother 2004; 54:489497.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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