title: Reporting of meticillin-resistant and -susceptible Staphylococcus aureus on death certificates in Irish hospitals.
abstract: The documentation of infection with meticillin-resistant Staphylococcus aureus (MRSA) on death certificates has been the subject of considerable public discussion. Using data from five tertiary referral hospitals in Ireland, we compared the documentation of MRSA and meticillin-susceptible S. aureus (MSSA) on death certificates in those patients who died in hospital within 30 days of having MRSA or MSSA isolated from blood cultures. A total of 133 patients had MRSA or MSSA isolated from blood cultures within 30 days of death during the study period. One patient was excluded as the death certificate information was not available; the other 132 patients were eligible for inclusion. MRSA and MSSA were isolated from blood cultures in 59 (44.4%) and 74 (55.6%) cases respectively. One patient was included as a case in both categories as both MRSA and MSSA were isolated from a blood culture. In 15 (25.4%) of the 59 MRSA cases, MRSA was documented on the death certificate. In nine (12.2%) of the 74 patients with MSSA cases, MSSA was documented on the death certificate. MRSA was more likely to be documented on the death certificate than MSSA (odds ratio: 2.46; 95% confidence interval: 1.01-6.01; P < 0.05). These findings indicate that there may be inconsistencies in the way organisms and infections are documented on death certificates in Ireland and that death certification data may underestimate the mortality related to certain organisms. In particular, there appears to be an overemphasis by certifiers on the documentation of MRSA compared with MSSA.
authors.affiliation: Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: C J
authors.initials: CJ
authors.lastname: Collins
authors.forename: M H
authors.initials: MH
authors.lastname: Fraher
authors.forename: K
authors.initials: K
authors.lastname: O'Connell
authors.forename: J
authors.initials: J
authors.lastname: Fennell
authors.forename: S F
authors.initials: SF
authors.lastname: FitzGerald
authors.forename: N
authors.initials: N
authors.lastname: O'Sullivan
authors.forename: M
authors.initials: M
authors.lastname: Cormican
authors.forename: L E
authors.initials: LE
authors.lastname: Fenelon
authors.forename: P
authors.initials: P
authors.lastname: Murphy
authors.forename: M M
authors.initials: MM
authors.lastname: Hannan
mesh_terms: D003644:Death Certificates; D018563:Disease Notification; D004282:Documentation / Q000592:standards; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*