Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.

Hdl Handle:
http://hdl.handle.net/10147/229136
Title:
Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.
Authors:
de Kraker, Marlieke E A; Wolkewitz, Martin; Davey, Peter G; Koller, Walter; Berger, Jutta; Nagler, Jan; Icket, Claudine; Kalenic, Smilja; Horvatic, Jasminka; Seifert, Harald; Kaasch, Achim J; Paniara, Olga; Argyropoulou, Athina; Bompola, Maria; Smyth, Edmond; Skally, Mairead; Raglio, Annibale; Dumpis, Uga; Kelmere, Agita Melbarde; Borg, Michael; Xuereb, Deborah; Ghita, Mihaela C; Noble, Michelle; Kolman, Jana; Grabljevec, Stanko; Turner, David; Lansbury, Louise; Grundmann, Hajo
Affiliation:
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherland. Marlieke.de.Kraker@RIVM.nl
Citation:
Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. 2011, 55 (4):1598-605 Antimicrob. Agents Chemother.
Journal:
Antimicrobial agents and chemotherapy
Issue Date:
Apr-2011
URI:
http://hdl.handle.net/10147/229136
DOI:
10.1128/AAC.01157-10
PubMed ID:
21220533
Additional Links:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067153/pdf/1157-10.pdf
Abstract:
Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.
Item Type:
Article
Language:
en
MeSH:
Aged; Europe; Female; Hospital Mortality; Hospitals; Humans; Length of Stay; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Prospective Studies; Staphylococcal Infections
ISSN:
1098-6596

Full metadata record

DC FieldValue Language
dc.contributor.authorde Kraker, Marlieke E Aen_GB
dc.contributor.authorWolkewitz, Martinen_GB
dc.contributor.authorDavey, Peter Gen_GB
dc.contributor.authorKoller, Walteren_GB
dc.contributor.authorBerger, Juttaen_GB
dc.contributor.authorNagler, Janen_GB
dc.contributor.authorIcket, Claudineen_GB
dc.contributor.authorKalenic, Smiljaen_GB
dc.contributor.authorHorvatic, Jasminkaen_GB
dc.contributor.authorSeifert, Haralden_GB
dc.contributor.authorKaasch, Achim Jen_GB
dc.contributor.authorPaniara, Olgaen_GB
dc.contributor.authorArgyropoulou, Athinaen_GB
dc.contributor.authorBompola, Mariaen_GB
dc.contributor.authorSmyth, Edmonden_GB
dc.contributor.authorSkally, Maireaden_GB
dc.contributor.authorRaglio, Annibaleen_GB
dc.contributor.authorDumpis, Ugaen_GB
dc.contributor.authorKelmere, Agita Melbardeen_GB
dc.contributor.authorBorg, Michaelen_GB
dc.contributor.authorXuereb, Deborahen_GB
dc.contributor.authorGhita, Mihaela Cen_GB
dc.contributor.authorNoble, Michelleen_GB
dc.contributor.authorKolman, Janaen_GB
dc.contributor.authorGrabljevec, Stankoen_GB
dc.contributor.authorTurner, Daviden_GB
dc.contributor.authorLansbury, Louiseen_GB
dc.contributor.authorGrundmann, Hajoen_GB
dc.date.accessioned2012-06-15T13:31:27Z-
dc.date.available2012-06-15T13:31:27Z-
dc.date.issued2011-04-
dc.identifier.citationClinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. 2011, 55 (4):1598-605 Antimicrob. Agents Chemother.en_GB
dc.identifier.issn1098-6596-
dc.identifier.pmid21220533-
dc.identifier.doi10.1128/AAC.01157-10-
dc.identifier.urihttp://hdl.handle.net/10147/229136-
dc.description.abstractAntimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.en_GB
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067153/pdf/1157-10.pdfen_GB
dc.rightsArchived with thanks to Antimicrobial agents and chemotherapyen_GB
dc.subject.meshAged-
dc.subject.meshEurope-
dc.subject.meshFemale-
dc.subject.meshHospital Mortality-
dc.subject.meshHospitals-
dc.subject.meshHumans-
dc.subject.meshLength of Stay-
dc.subject.meshMale-
dc.subject.meshMethicillin-Resistant Staphylococcus aureus-
dc.subject.meshMiddle Aged-
dc.subject.meshProspective Studies-
dc.subject.meshStaphylococcal Infections-
dc.titleClinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.en_GB
dc.typeArticleen
dc.contributor.departmentCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherland. Marlieke.de.Kraker@RIVM.nlen_GB
dc.identifier.journalAntimicrobial agents and chemotherapyen_GB
dc.description.provinceLeinsteren

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