title: Predictive factors of meticillin resistance among patients with Staphylococcus aureus bloodstream infections at hospital admission.
abstract: Meticillin-resistant Staphylococcus aureus (MRSA) is prevalent throughout the healthcare system in Spain, particularly in long-term care facilities (LTCF) and the incidence of MRSA bloodstream infection (MRSA-BSI) at hospital admission is increasing. This study aimed to determine factors that predict meticillin resistance among patients who require hospitalization for S. aureus BSI. We performed a case-control study comparing patients with S. aureus at hospital admission from January 1991 to December 2003. Case patients with MRSA-BSI at hospital admission (N=50) were compared with control patients with meticillin-susceptible S. aureus bloodstream infection (MSSA-BSI) at hospital admission (N=98). The incidence of MRSA-BSI at hospital admission increased significantly from 0.08 cases/1000 hospital admissions in 1991 to 0.37 cases in 2003 (P<0.001). Univariate analysis comparing patients with MRSA- and MSSA-BSI found a significant association between meticillin resistance and age >60 years, female sex, prior MRSA isolation and healthcare-related BSI. No differences were found in underlying conditions such as diabetes, haemodialysis, immunosuppression, source of infection or mortality between the two groups. Multivariate analyses identified prior MRSA isolation [odds ratio (OR): 41; 95% confidence interval (CI): 4-350] and admission from long-term care facilities (OR: 37; 95% CI: 4.5-316) as independent risk factors for MRSA-BSI.
authors.affiliation: Infectious Diseases Service, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Manzur
authors.forename: M
authors.initials: M
authors.lastname: Vidal
authors.forename: M
authors.initials: M
authors.lastname: Pujol
authors.forename: M
authors.initials: M
authors.lastname: Cisnal
authors.forename: A
authors.initials: A
authors.lastname: Hornero
authors.forename: C
authors.initials: C
authors.lastname: Masuet
authors.forename: C
authors.initials: C
authors.lastname: Peña
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
authors.forename: J
authors.initials: J
authors.lastname: Ariza
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects*