Shurland Simone, Zhan Min, Bradham Douglas D, Roghmann Mary-Claire
Department of Epidemiology and Preventive Medicine, Division of Health Outcomes Research, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.
Infect Control Hosp Epidemiol. 2007 Mar;28(3):273-9. doi: 10.1086/512627. Epub 2007 Feb 15.
To quantify the clinical impact of methicillin-resistance in Staphylococcus aureus causing infection complicated by bacteremia in adult patients, while controlling for the severity of patients' underlying illnesses.
Retrospective cohort study from October 1, 1995, through December 31, 2003.
A total of 438 patients with S. aureus infection complicated by bacteremia from a single Veterans Affairs healthcare system.
We found that 193 (44%) of the 438 patients had methicillin-resistant S. aureus (MRSA) infection and 114 (26%) died of causes attributable to S. aureus infection within 90 days after the infection was identified. Patients with MRSA infection had a higher mortality risk, compared with patients with methicillin-susceptible S. aureus (MSSA) infections (relative risk, 1.7 [95% confidence interval, 1.3-2.4]; P<.01), except for patients with pneumonia (relative risk, 0.7 [95% confidence interval, 0.4-1.3]). Patients with MRSA infections were significantly older (P<.01), had more underlying diseases (P=.02), and were more likely to have severe sepsis in response to their infection (P<.01) compared with patients with MSSA bacteremia. Patients who died within 90 days after S. aureus infection was identified were significantly older (P<.01) and more likely to have severe sepsis (P<.01) and pneumonia (P=.01), compared with patients who survived. After adjusting for age as a confounder, comorbidities, and pneumonia as an effect modifier, S. aureus infection-related mortality remained significantly higher in patients with MRSA infection than in those with MSSA infection, among those without pneumonia (hazard ratio, 1.8 [95% confidence interval, 1.2-3.0]); P<.01.
The results of this study suggest that patients with MRSA infections other than pneumonia have a higher mortality risk than patients with MSSA infections other than pneumonia, independent of the severity of patients' underlying illnesses.
在控制成年患者基础疾病严重程度的同时，量化耐甲氧西林金黄色葡萄球菌导致感染并伴有菌血症的临床影响。
1995年10月1日至2003年12月31日的回顾性队列研究。
来自单一退伍军人事务医疗系统的438例金黄色葡萄球菌感染并伴有菌血症的患者。
我们发现，438例患者中有193例（44%）为耐甲氧西林金黄色葡萄球菌（MRSA）感染，114例（26%）在感染确诊后90天内死于金黄色葡萄球菌感染相关原因。与甲氧西林敏感金黄色葡萄球菌（MSSA）感染患者相比，MRSA感染患者的死亡风险更高（相对风险，1.7[95%置信区间，1.3 - 2.4]；P<0.01），但肺炎患者除外（相对风险，0.7[95%置信区间，0.4 - 1.3]）。与MSSA菌血症患者相比，MRSA感染患者年龄显著更大（P<0.01），基础疾病更多（P = 0.02），且因感染更易发生严重脓毒症（P<0.01）。与存活患者相比，在金黄色葡萄球菌感染确诊后90天内死亡的患者年龄显著更大（P<0.01），更易发生严重脓毒症（P<0.01）和肺炎（P = 0.01）。在将年龄作为混杂因素、合并症以及肺炎作为效应修饰因素进行校正后，在无肺炎的患者中，MRSA感染患者的金黄色葡萄球菌感染相关死亡率仍显著高于MSSA感染患者（风险比，1.8[95%置信区间，1.2 - 3.0]）；P<0.01。
本研究结果表明，除肺炎外，MRSA感染患者的死亡风险高于MSSA感染患者，且与患者基础疾病的严重程度无关。
