| The risk factors and prognosis of methicillin-resistant staphylococcus aureus bacteremia : focus on nosocomial acquisition |
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Su Hyun Kim, Jung Hwa Ryu, Myung Shin Kim, Hee Jung Choi |
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고려대학교 의과대학 내과학교실 |
| 원저: 병원획득을 중심으로 한 메티실린 내성 황색 포도알균 균혈증의 위험인자와 예후 |
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김수현, Jung Hwa Ryu, Myung Shin Kim, Hee Jung Choi |
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| Abstract |
Background : Staphylococcus aureus is the most common pathogen causing nosocomial infection;
it contributes significantly to patient morbidity and mortality. The incidence of S. aureus bacteremia
in hospitals as well as communities has significantly increased during the past decade. The purpose
of this study was to determine the risk factors and prognosis of methicillin-resistant S. aureus
bacteremia.
Methods
: We reviewed the medical records of 164 cases of S. aureus bacteremia during
1999-2003 at the Ewha Womans University MokDong hospital. We retrospectively analyzed the
cases, which satisfied the definition of clinically significant bacteremia and whose medical records
were available.
Results
: The number of methicillin-sensitive Staphylococcus aureus infections (MSSA) was 87
cases and methicillin-resistant Staphylococcus aureus (MRSA) 77 cases. There were 65 cases
(84.4%) of nosocomial infection, 9 cases (11.7%) of health-care associated and 3 cases (3.9%) of
community-acquired MRSA bacteremia. The risk factors associated with nosocomial MRSA were
previous use of antibiotics (OR 15.6, p<0.001) and advanced age (OR 4.9, p=0.017). The risk factor
for increased mortality in patients with nosocomial S. aureus bacteremia was septic shock (Hazard
ratio 13.2, p<0.001).
Conclusions
: MRSA bacteremia was more frequent in patients with previous antibiotic therapy
and advanced age. In addition, the risk factor for mortality in patients with S. aureus bacteremia was
septic shock. Additional prospective randomized trials to assess the efficacy and initiation of empirical
antibiotics in a well matched cohort study are necessary.(Korean J Med 71:405-414, 2006)
Key Words : Staphylococcus aureus bacteremia, Risk factors, Prognosis, Methicillin-resistance |
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