Melony C Fortuin-de Smidt1, Ashika Singh-Moodley2, Rubeina Badat1, Vanessa Quan1, Ranmini Kularatne3, Trusha Nana3, Ruth Lekalakala4, Nelesh P Govender2, Olga Perovic5. 1. National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa. 2. National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 3. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa. 4. Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division, National Health Laboratory Service, Gauteng, South Africa. 5. National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: olgap@nicd.ac.za.
Abstract
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible for longer hospital stays, increased hospital costs, and poorer outcomes compared to methicillin-sensitive S. aureus (MSSA) infections. We aimed to describe the epidemiology of S. aureus bacteraemia (SAB) and to determine factors associated with MRSA infection in South Africa. METHODS: Cases of SAB were reported from September 2012 to September 2013 from three sentinel sites. A case was defined as the isolation of S. aureus from a blood culture during a 21-day period. Detailed clinical information was collected. Multivariable logistic regression was done to determine factors associated with MRSA infection and mortality. RESULTS: There were 442 cases of SAB reported; antimicrobial susceptibility testing was performed on 240 isolates (54%). Thirty-six percent (86/240) of cases had an MRSA infection. A longer hospital stay before positive specimen collection (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02-1.13, p=0.004), hospitalization in the last year (OR 15.7, 95% CI 2.5-99.5, p=0.003), HIV infection (OR 4.9, 95% CI 1.05-22.90, p=0.044), and antibiotic use in the previous 2 months (OR 0.1, 95% CI 0.01-0.68, p=0.022) were independent predictors of MRSA. Older age, and in particular age 25-44 years (OR 22.2, 95% CI 2.7-185.5, p=0.004, compared to those aged<5 years), was the only independent predictor of mortality amongst cases with SAB. MRSA isolates were non-susceptible to more antimicrobial agents compared to MSSA isolates. CONCLUSIONS: HIV infection was an independent risk factor for MRSA infection. The selection of appropriate empirical antimicrobial treatment is essential in patients with MRSA infections because of non-susceptibility to many other antimicrobial classes.
INTRODUCTION:Methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible for longer hospital stays, increased hospital costs, and poorer outcomes compared to methicillin-sensitive S. aureus (MSSA) infections. We aimed to describe the epidemiology of S. aureus bacteraemia (SAB) and to determine factors associated with MRSA infection in South Africa. METHODS: Cases of SAB were reported from September 2012 to September 2013 from three sentinel sites. A case was defined as the isolation of S. aureus from a blood culture during a 21-day period. Detailed clinical information was collected. Multivariable logistic regression was done to determine factors associated with MRSA infection and mortality. RESULTS: There were 442 cases of SAB reported; antimicrobial susceptibility testing was performed on 240 isolates (54%). Thirty-six percent (86/240) of cases had an MRSA infection. A longer hospital stay before positive specimen collection (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02-1.13, p=0.004), hospitalization in the last year (OR 15.7, 95% CI 2.5-99.5, p=0.003), HIV infection (OR 4.9, 95% CI 1.05-22.90, p=0.044), and antibiotic use in the previous 2 months (OR 0.1, 95% CI 0.01-0.68, p=0.022) were independent predictors of MRSA. Older age, and in particular age 25-44 years (OR 22.2, 95% CI 2.7-185.5, p=0.004, compared to those aged<5 years), was the only independent predictor of mortality amongst cases with SAB. MRSA isolates were non-susceptible to more antimicrobial agents compared to MSSA isolates. CONCLUSIONS:HIV infection was an independent risk factor for MRSA infection. The selection of appropriate empirical antimicrobial treatment is essential in patients with MRSA infections because of non-susceptibility to many other antimicrobial classes.
Authors: O Perovic; A Singh-Moodley; N P Govender; R Kularatne; A Whitelaw; V Chibabhai; P Naicker; N Mbelle; R Lekalakala; V Quan; C Samuel; E Van Schalkwyk Journal: Eur J Clin Microbiol Infect Dis Date: 2017-08-28 Impact factor: 3.267