Is methicillin-resistant Staphylococcus Aureus infection associated with higher mortality and morbidity in hospitalized patients? A cohort study of 551 patients from South Western India
Received 6 June 2018
Accepted for publication 10 October 2018
Published 3 December 2018 Volume 2018:11 Pages 243—250
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Kent Rondeau
Aparajita Chatterjee,1 Shipra Rai,1 Vasudeva Guddattu,2 Chiranjay Mukhopadhyay,3 Kavitha Saravu1,4
1Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India; 2Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India; 3Department of Microbiology, Kasturba Medical College Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India; 4Manipal McGill Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Madhav Nagar, Karnataka, India
Purpose: To determine morbidity and mortality of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) infections in a tertiary health care facility.
Methods: A cohort study among hospitalized adult patients with culture proven MRSA or MSSA monoinfection were recruited in a tertiary referral center in South India from November 2011 to December 2012.
Results: Of total 551 subjects, 284 (52%) had MRSA and 267 (48%) MSSA infection. A total of 184 (65%) subjects had health care-associated MRSA (HA-MRSA) and 100 (35%) community-associated MRSA (CA-MRSA). Chronic kidney disease and recent antibiotic use had significant association with MRSA. MRSA patients had significant respiratory infection (OR 2.24 [1.04, 5.16]) and bacteremia (OR 2.24 [10.40, 5.16]), relative to MSSA. MSSA group had better survival function compared to MRSA group (P=0.028). Median duration of ICU stays were 5 days (IQR 4, 8) and 2 days (IQR 2, 2) in MRSA and MSSA, respectively. Complications such as acute kidney injury, sepsis, multiorgan dysfunction, need for supportive measures were more in the MRSA group.
Conclusion: MRSA imposes a huge burden in Indian scenario and HA-MRSA remains the main culprit. Patients with history of chronic kidney disease and recent use of antibiotics were found to be at a higher risk. Patients with MRSA infections tend to have poorer outcomes in terms of longer hospital stay, greater complications, and mortality.
Keywords: methicillin-resistant Staphylococcus aureus, Staphylococcus aureus, risk factors, outcome, mortality, India, prognosis, impact, morbidity
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