title: Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study.
abstract: OBJECTIVE
  The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia.
  
  
  METHODS
  All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (≥ 7 days) and nonpersistent MRSA bacteremia (≤ 3 days).
  
  
  RESULTS
  Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029).
  
  
  CONCLUSIONS
  High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.
authors.affiliation: Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Hea Sung
authors.initials: HS
authors.lastname: Ok
authors.forename: Hyoun Soo
authors.initials: HS
authors.lastname: Lee
authors.forename: Man Je
authors.initials: MJ
authors.lastname: Park
authors.forename: Ki Hoon
authors.initials: KH
authors.lastname: Kim
authors.forename: Byeong Ki
authors.initials: BK
authors.lastname: Kim
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Wi
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015897:Comorbidity; D020878:Device Removal; D005260:Female; D006742:Hospital Bed Capacity; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000382:microbiology / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D056910:Republic of Korea; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Methicillin-resistant Staphylococcus aureus; Mortality; Persistent