TY - JOUR
T1 - Staphylococcus aureus bloodstream infections in Latin America
T2 - Results of a multinational prospective cohort study
AU - on behalf of the Latin American Working Group on Antimicrobial Resistance
AU - Seas, Carlos
AU - Garcia, Coralith
AU - Salles, Mauro J.
AU - Labarca, Jaime
AU - Luna, Carlos
AU - Alvarez-Moreno, Carlos
AU - Mejía-Villatoro, Carlos
AU - Zurita, Jeannete
AU - Guzmán-Blanco, Manuel
AU - Rodríguez-Noriega, Eduardo
AU - Reyes, Jinnethe
AU - Arias, Cesar A.
AU - Carcamo, Cesar
AU - Gotuzzo, Eduardo
AU - Bruno, Didier
AU - Efron, Ernesto
AU - Del Castillo, Marcelo
AU - Dei, Sanatorio Mater
AU - Guimarães, Thaís
AU - Ceballos, María Elena
AU - Domínguez, Isabel
AU - Riedel, Gisela
AU - Valderrama, Sandra Liliana
AU - Gualtero, Sandra Milena
AU - Saavedra, Carlos Humberto
AU - Tello, Betzabé
AU - Guerrero, Fausto
AU - Silvestre, María Mónica
AU - Morfin-Otero, Rayo
AU - Alcalde, Fray Antonio
AU - Hidalgo, Jose
AU - Hercilla, Luis
AU - Cáceres Hernández, Ana María
AU - Silva, Marisela
AU - Guzmán, Alfonso José
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries. Objectives: To assess the clinical impact of SAB in Latin America. Patients and methods: We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model. Results: A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P < 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P=0.616] or in a sensitivity analysis using 30 day allcause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P=0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with b-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P=0.602). Conclusions: MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.
AB - Background: Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries. Objectives: To assess the clinical impact of SAB in Latin America. Patients and methods: We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model. Results: A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P < 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P=0.616] or in a sensitivity analysis using 30 day allcause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P=0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with b-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P=0.602). Conclusions: MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.
UR - http://www.scopus.com/inward/record.url?scp=85040580308&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040580308&partnerID=8YFLogxK
U2 - 10.1093/jac/dkx350
DO - 10.1093/jac/dkx350
M3 - Article
C2 - 29045648
AN - SCOPUS:85040580308
SN - 0305-7453
VL - 73
SP - 212
EP - 222
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 1
M1 - dkx350
ER -