title: Methicillin-resistant Staphylococcus aureus bacteremia at a university hospital in Japan.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has become a leading cause of infections in hospitals, and mortality from MRSA bacteremia is high. In this study, we assessed the clinical characteristics and optimum management of 115 patients with MRSA bacteremia who were admitted to Osaka University Hospital between January 2006 and December 2010. Sixty-nine of the patients survived and 46 died of heart failure or renal failure. The nonsurvivors had reduced levels of platelets and albumin, and increased aspartate aminotransferase, total bilirubin, blood urea nitrogen, and creatinine levels. Other causes of death included sepsis, septic shock plus respiratory failure, disseminated intravascular coagulation, and unknown causes. However, a significant number of those whose infections were catheter-derived survived. Nonsurvivors were more often administered catecholamines and consultation with an infection-control team (ICT) was significantly associated with improved survival. Patients about whom the ICT were consulted were administered significantly more additional anti-MRSA drugs, for example trimethoprim-sulfamethoxazole, clindamycin, and gentamycin, than patients who were not the subject of consultation, although trough values for vancomycin did not differ between the two groups. Catheter removal was significantly higher for surviving patients with severe or complicated infections. These results suggest the status of patients with MRSA bacteremia who did not survive was worse than those who did survive, but that ICT consultation might significantly affect survival by recommendation of appropriate care and anti-MRSA drug use.
authors.affiliation: Division of Infection Control and Prevention, Osaka University Graduate School of Medical Sciences, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Etsuko
authors.initials: E
authors.lastname: Uejima
authors.forename: Masafumi
authors.initials: M
authors.lastname: Seki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamagishi
authors.forename: Koji
authors.initials: K
authors.lastname: Miyawaki
authors.forename: Kaori
authors.initials: K
authors.lastname: Yabuno
authors.forename: Mari
authors.initials: M
authors.lastname: Masaoka
authors.forename: Shigeto
authors.initials: S
authors.lastname: Hamaguchi
authors.forename: Nori
authors.initials: N
authors.lastname: Yoshioka
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control; D007564:Japan; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D016019:Survival Analysis