title: Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia.
abstract: OBJECTIVE
  To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia.
  
  
  METHODS
  A multicenter, retrospective cohort study conducted in 2005-2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillin-resistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality.
  
  
  RESULTS
  A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21 mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender.
  
  
  CONCLUSIONS
  Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory.
authors: Grupo de investigación en enfermedades infecciosas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. jscastillol@unal.edu.co
authors: Juan S
authors: JS
authors: Castillo
authors: Aura L
authors: AL
authors: Leal
authors: Jorge A
authors: JA
authors: Cortes
authors: Carlos A
authors: CA
authors: Alvarez
authors: Ricardo
authors: R
authors: Sanchez
authors: Giancarlo
authors: G
authors: Buitrago
authors: Liliana I
authors: LI
authors: Barrero
authors: Andrés L
authors: AL
authors: Gonzalez
authors: Daibeth H
authors: DH
authors: Henriquez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality*; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality*; D055815:Young Adult