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Risk for death after discharge increases with hospital-acquired MRSA
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Researchers found that MRSA bacteremia did not increase the risk for death in hospitalized children compared with methicillin-susceptible Staphylococcus Aureus, or MSSA. However, MRSA infections acquired in the hospital were associated with an increased risk for mortality 1 year after discharge.
Oren Gordon, MD, PhD, a pediatric infectious disease fellow at the Johns Hopkins University School of Medicine, and colleagues wrote that two meta-analyses conducted in the early 2000s examined mortality rates of patients with MRSA compared with those with MSSA. However, they wrote that the baseline mortality risk varied considerably in the studies, as did the researchers’ attempts to adjust for potential confounders. Additionally, few pediatric cases were included in these analyses.
“More recent studies have documented the morbidity and mortality related to SA bacteremia in children,” Gordon and colleagues wrote. “Although a few found increased mortality in MRSA bacteremia compared with MSSA bacteremia, others have not.”
The researchers examined data collected on all S. aureus (SA)-related bloodstream infections among children aged 0 to 16 years between 2002 and 2016. All patients were treated at the Hadassah Medical Center, a tertiary hospital in Jerusalem. Any positive cultures collected within 48 hours of hospital admission were defined as community acquired (CA). Those obtained afterward or from children hospitalized within the previous year were considered health care associated (HA).
During the study period, 427 infections were identified, with 66% occurring in the health care setting. MRSA was present in 15% of cultures, and 2% were CA-MRSA. The researchers said there was no increase in MRSA during the study period. Short-term mortality after SA bacteremia was low, the researchers noted — 3% in-hospital and 3.5% 30 days after discharge — whereas 1-year mortality was 12%.
In a multivariable analysis controlling for demographics, admitting department and prior morbidity, children who were infected with MRSA in a health care setting had an increased risk for death 1 year after discharge (HR = 4.1; 95% CI, 1.3-12). Those with prior chronic disease also were at increased risk for mortality 1 year after discharge (HR = 3.4; 95% CI, 1.2-9). Compared with MSSA, MRSA was not independently associated with an increased risk for mortality after 1 year (HR = 1.4; 95% CI, 0.6-3.1).
Based on these findings, the researchers suggested that most SA-bacteremia events in hospitalized children at their institution are HA infections and potentially could have been prevented.
“In fact, there has been a modest decline in the last 10 years in HA-SA bacteremia events in our institution,” they wrote. “This may be attributed to ongoing efforts to reduce nosocomial infection in hospitalized children.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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