Staphylococcus aureus bloodstream infections in Latin America: Results of a multinational prospective cohort study

on behalf of the Latin American Working Group on Antimicrobial Resistance

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numberdkx350
Pages (from-to)212-222
Number of pages11
JournalJournal of Antimicrobial Chemotherapy
Volume73
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Latin America
Staphylococcus aureus
Methicillin-Resistant Staphylococcus aureus
Cohort Studies
Prospective Studies
Mortality
Bacteremia
Infection
Length of Stay
Lactams
Linear Models
Epidemiology
Therapeutics
Research Personnel

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Staphylococcus aureus bloodstream infections in Latin America : Results of a multinational prospective cohort study. / on behalf of the Latin American Working Group on Antimicrobial Resistance.

In: Journal of Antimicrobial Chemotherapy, Vol. 73, No. 1, dkx350, 01.01.2018, p. 212-222.

Research output: Contribution to journalArticle

on behalf of the Latin American Working Group on Antimicrobial Resistance. / Staphylococcus aureus bloodstream infections in Latin America : Results of a multinational prospective cohort study. In: Journal of Antimicrobial Chemotherapy. 2018 ; Vol. 73, No. 1. pp. 212-222.
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abstract = "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.",
author = "{on behalf of the Latin American Working Group on Antimicrobial Resistance} and Carlos Seas and Coralith Garcia and Salles, {Mauro J.} and Jaime Labarca and Carlos Luna and Carlos Alvarez-Moreno and Carlos Mej{\'i}a-Villatoro and Jeannete Zurita and Manuel Guzm{\'a}n-Blanco and Eduardo Rodr{\'i}guez-Noriega and Jinnethe Reyes and Arias, {Cesar A.} and Cesar Carcamo and Eduardo Gotuzzo and Didier Bruno and Ernesto Efron and {Del Castillo}, Marcelo and Dei, {Sanatorio Mater} and Tha{\'i}s Guimar{\~a}es and Ceballos, {Mar{\'i}a Elena} and Isabel Dom{\'i}nguez and Gisela Riedel and Valderrama, {Sandra Liliana} and Gualtero, {Sandra Milena} and Saavedra, {Carlos Humberto} and Betzab{\'e} Tello and Fausto Guerrero and Silvestre, {Mar{\'i}a M{\'o}nica} and Rayo Morfin-Otero and Alcalde, {Fray Antonio} and Jose Hidalgo and Luis Hercilla and {C{\'a}ceres Hern{\'a}ndez}, {Ana Mar{\'i}a} and Marisela Silva and Guzm{\'a}n, {Alfonso Jos{\'e}}",
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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

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.

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