Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: results from the EPIC II study
Identifieur interne : 006A02 ( Main/Exploration ); précédent : 006A01; suivant : 006A03Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: results from the EPIC II study
Auteurs : H Kan Hanberger [Suède] ; Sten Walther [Suède] ; Marc Leone [France] ; Philip S. Barie [États-Unis] ; Jordi Rello [Espagne] ; Jeffrey Lipman [Australie] ; John C. Marshall [Canada] ; Antonio Anzueto [États-Unis] ; Yasser Sakr [Allemagne] ; Peter Pickkers [Pays-Bas] ; Peter Felleiter [Suisse] ; Milo Engoren [États-Unis] ; Jean-Louis Vincent [Belgique]Source :
- International journal of antimicrobial agents : (Print) [ 0924-8579 ] ; 2011.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Mortalité.
English descriptors
- KwdEn :
Abstract
Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P< 0.01 ) and corresponding hospital mortality rates were 36.4% and 27.0% (P< 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P= 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.
Affiliations:
- Allemagne, Australie, Belgique, Canada, Espagne, France, Pays-Bas, Suisse, Suède, États-Unis
- Catalogne, Gueldre, Ontario, Provence-Alpes-Côte d'Azur, Vienne (Autriche)
- Barcelone, Bruxelles, Marseille, Nimègue, Toronto, Vienne (Autriche)
- Université autonome de Barcelone, Université de Toronto, Université libre de Bruxelles
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Marshall</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Department of Surgery, University of Toronto, St Michael's Hospital, Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Pulmonary/Critical Care, University of Texas Health Science Center</s1><s2>San Antonio, TX</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>San Antonio, TX</wicri:noRegion></affiliation></author><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University</s1><s2>Jena</s2><s3>DEU</s3><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Friedrich-Schiller University</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author><author><name sortKey="Pickkers, Peter" sort="Pickkers, Peter" uniqKey="Pickkers P" first="Peter" last="Pickkers">Peter Pickkers</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>10 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Felleiter, Peter" sort="Felleiter, Peter" uniqKey="Felleiter P" 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Walther</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University</s1><s2>Linköping</s2><s3>SWE</s3><sZ>2 aut.</sZ></inist:fA14><country>Suède</country><wicri:noRegion>Linköping</wicri:noRegion></affiliation></author><author><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Anesthesiology and Intensive Care Medicine, Nord Hospital</s1><s2>Marseille</s2><s3>FRA</s3><sZ>3 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Barie, Philip S" sort="Barie, Philip S" uniqKey="Barie P" first="Philip S." last="Barie">Philip S. Barie</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Surgery, Weill Cornell Medical College, 1300 York Ave., P713A</s1><s2>New York, NY 10021</s2><s3>USA</s3><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>New York, NY 10021</wicri:noRegion></affiliation></author><author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autónoma de Barcelona</s1><s3>ESP</s3><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><orgName type="university">Université autonome de Barcelone</orgName></affiliation></author><author><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and Bums Trauma Critical Care Research Centre, University of Queensland</s1><s2>Queensland</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Queensland</wicri:noRegion></affiliation></author><author><name sortKey="Marshall, John C" sort="Marshall, John C" uniqKey="Marshall J" first="John C." last="Marshall">John C. Marshall</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Department of Surgery, University of Toronto, St Michael's Hospital, Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Pulmonary/Critical Care, University of Texas Health Science Center</s1><s2>San Antonio, TX</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>San Antonio, TX</wicri:noRegion></affiliation></author><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University</s1><s2>Jena</s2><s3>DEU</s3><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Friedrich-Schiller University</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author><author><name sortKey="Pickkers, Peter" sort="Pickkers, Peter" uniqKey="Pickkers P" first="Peter" last="Pickkers">Peter Pickkers</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre</s1><s2>Nijmegen</s2><s3>NLD</s3><sZ>10 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Felleiter, Peter" sort="Felleiter, Peter" uniqKey="Felleiter P" first="Peter" last="Felleiter">Peter Felleiter</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Intensive Care Medicine, Swiss Paraplegic Centre</s1><s2>6207 Nottwil</s2><s3>CHE</s3><sZ>11 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>6207 Nottwil</wicri:noRegion></affiliation></author><author><name sortKey="Engoren, Milo" sort="Engoren, Milo" uniqKey="Engoren M" first="Milo" last="Engoren">Milo Engoren</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Department of Anesthesiology, Mercy St Vincent Medical Center</s1><s2>Toledo, OH</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Toledo, OH</wicri:noRegion></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="4"><inist:fA14 i1="13"><s1>Department of Intensive Care, Erasme Hospital, Universite libre de Bruxelles, Route de Lennik 808</s1><s2>1070 Brussels</s2><s3>BEL</s3><sZ>13 aut.</sZ></inist:fA14><country>Belgique</country><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement><settlement type="city">Bruxelles</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author></analytic><series><title level="j" type="main">International journal of antimicrobial agents : (Print)</title><title level="j" type="abbreviated">Int. j. antimicrob. agents : (Print)</title><idno type="ISSN">0924-8579</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">International journal of antimicrobial agents : (Print)</title><title level="j" type="abbreviated">Int. j. antimicrob. agents : (Print)</title><idno type="ISSN">0924-8579</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antimicrobial agent</term><term>Bacteremia</term><term>Critically ill</term><term>Drug susceptibility test</term><term>Intensive care unit</term><term>Mortality</term><term>Resistance</term><term>Sepsis syndrome</term><term>Staphylococcal infection</term><term>Staphylococcus aureus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Mortalité</term><term>Staphylococcus aureus</term><term>Staphylococcie</term><term>Unité soin intensif</term><term>Test sensibilité médicamenteuse</term><term>Antimicrobien</term><term>Résistance</term><term>Bactériémie</term><term>Syndrome septique</term><term>Malade état grave</term><term>Souche résistante méticilline</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P< 0.01 ) and corresponding hospital mortality rates were 36.4% and 27.0% (P< 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P<sub>=</sub> 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Belgique</li><li>Canada</li><li>Espagne</li><li>France</li><li>Pays-Bas</li><li>Suisse</li><li>Suède</li><li>États-Unis</li></country><region><li>Catalogne</li><li>Gueldre</li><li>Ontario</li><li>Provence-Alpes-Côte d'Azur</li><li>Vienne (Autriche)</li></region><settlement><li>Barcelone</li><li>Bruxelles</li><li>Marseille</li><li>Nimègue</li><li>Toronto</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université autonome de Barcelone</li><li>Université de Toronto</li><li>Université libre de Bruxelles</li></orgName></list><tree><country name="Suède"><noRegion><name sortKey="Hanberger, H Kan" sort="Hanberger, H Kan" uniqKey="Hanberger H" first="H Kan" last="Hanberger">H Kan Hanberger</name></noRegion><name sortKey="Walther, Sten" sort="Walther, Sten" uniqKey="Walther S" first="Sten" last="Walther">Sten Walther</name></country><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name></region></country><country name="États-Unis"><noRegion><name sortKey="Barie, Philip S" sort="Barie, Philip S" uniqKey="Barie P" first="Philip S." last="Barie">Philip S. Barie</name></noRegion><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name><name sortKey="Engoren, Milo" sort="Engoren, Milo" uniqKey="Engoren M" first="Milo" last="Engoren">Milo Engoren</name></country><country name="Espagne"><region name="Catalogne"><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name></region></country><country name="Australie"><noRegion><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name></noRegion></country><country name="Canada"><region name="Ontario"><name sortKey="Marshall, John C" sort="Marshall, John C" uniqKey="Marshall J" first="John C." last="Marshall">John C. Marshall</name></region></country><country name="Allemagne"><noRegion><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name></noRegion></country><country name="Pays-Bas"><region name="Gueldre"><name sortKey="Pickkers, Peter" sort="Pickkers, Peter" uniqKey="Pickkers P" first="Peter" last="Pickkers">Peter Pickkers</name></region></country><country name="Suisse"><noRegion><name sortKey="Felleiter, Peter" sort="Felleiter, Peter" uniqKey="Felleiter P" first="Peter" last="Felleiter">Peter Felleiter</name></noRegion></country><country name="Belgique"><region name="Vienne (Autriche)"><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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