RESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) infection is known to increase in-hospital mortality, but little is known about its association with long-term health. Two hundred and thirty-seven deaths occurred among 707 patients with MRSA infection at the time of hospitalization and/or nasal colonization followed for almost 4 years after discharge from the Atlanta Veterans Affairs Medical Center, USA. The crude mortality rate in patients with an infection and colonization (23·57/100 person-years) was significantly higher than the rate in patients with only colonization (15·67/100 person-years, P = 0·037). MRSA infection, hospitalization within past 6 months, and histories of cancer or haemodialysis were independent risk factors. Adjusted mortality rates in patients with infection were almost twice as high compared to patients who were only colonized: patients infected and colonized [hazard ratio (HR) 1·93, 95% confidence interval (CI) 1·31-2·84]; patients infected but not colonized (HR 1·96, 95% CI 1·22-3·17). Surviving MRSA infection adversely affects long-term mortality, underscoring the importance of infection control in healthcare settings.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Alta do Paciente/estatística & dados numéricos , Infecções Estafilocócicas/mortalidade , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Georgia/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/microbiologia , Modelos de Riscos Proporcionais , Diálise Renal/efeitos adversos , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Fatores de TempoRESUMO
We sought to define the prevalence of blaZ gene types and the inoculum effect to cefazolin among methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. The blaZ gene was present in 142/185 (77%) isolates. A total of 50 (27%) isolates had a ≥4-fold increase in the cefazolin MIC from a standard to a high inoculum, and 8 (4%) demonstrated a nonsusceptible cefazolin MIC, all type A blaZ strains. The efficacy of cefazolin in the presence of the inoculum effect requires further study.