Identifying patient-level risk factors associated with non-β-lactam resistance outcomes in invasive methicillin-resistant Staphylococcus aureus infections in the United States using chain graphs

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of hospital- and community-acquired infections. MRSA is resistant to many antibiotics, including β-lactam antibiotics, fluoroquinolones, lincosamides, macrolides, aminoglycosides, tetracyclines, and chloramphenicol. Graphical models such as chain graphs can be used to quantify and visualize the interactions among multiple resistant outcomes and their explanatory variables. In this study, we analyzed MRSA surveillance data collected by the Centers for Disease Control and Prevention (CDC) as part of the Emerging Infections Program (EIP) using chain graphs with the objective of identifying risk factors for individual phenotypic resistance outcomes (reported as minimum inhibitory concentration, MIC) while considering the correlations among themselves. Some phenotypic resistances have low connectivity to other outcomes or predictors (e.g. tetracycline, vancomycin, doxycycline, and rifampin). Levofloxacin was the only resistant associated with healthcare use. Blood culture was the most common predictor of MIC. Patients with positive blood culture had significantly increased MIC to chloramphenicol, erythromycin, gentamicin, lincomycin, and mupirocin, and decreased daptomycin and rifampin MICs. Chain graphs show the unique and common risk factors associated with resistance outcomes.

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1230. Epidemiology and Risk Factors for Recurrent Invasive Methicillin-Resistant Staphylococcus aureus Infection: nine US States, 2006–2013

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1063 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S373-S374

Author(s):

Ian Kracalik ◽

Kelly Jackson ◽

Joelle Nadle ◽

Wendy Bamberg ◽

Susan Petit ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Infection Type ◽

The United States ◽

Emerging Infections ◽

Methicillin Resistant ◽

Initial Infection ◽

Joint Infections ◽

Mrsa Infection

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) causes >70,000 invasive infections annually in the United States, and recurrent infections pose a major clinical challenge. We examined risk factors for recurrent MRSA infections. Methods We identified patients with an initial invasive MRSA infection (isolation from a normally sterile body site) from 2006 to 2013, through active, population-based surveillance in selected counties in nine states through the Emerging Infections Program. Recurrence was defined as invasive MRSA isolation >30 days after initial isolation. We used logistic regression with backwards selection to evaluate adjusted odds ratios (aOR) associated with recurrence within 180 days, prior healthcare exposures, and initial infection type, controlling for patient demographics and comorbidities. Results Among 24,478 patients with invasive MRSA, 3,976 (16%) experienced a recurrence, including 61% (2,438) within 180 days. Risk factors for recurrence were: injection drug use (IDU) (aOR; 1.38, 95% confidence interval [CI]: 1.15–1.65), central venous catheters (aOR; 1.35, 95% CI: 1.22–1.51), dialysis (aOR; 2.00, 95% CI: 1.74–2.31), and history of MRSA colonization (aOR; 1.35, 95% CI: 1.22–1.51) (figure). Recurrence was more likely for bloodstream infections (BSI) without another infection (aOR; 2.08, 95% CI: 1.74–2.48), endocarditis (aOR; 1.46, 95% CI: 1.16–1.55), and bone/joint infections (aOR; 1.38, 95% CI: 1.20–1.59), and less likely for pneumonia (aOR: 0.75, 95% CI: 0.64–0.89), compared with other initial infection types. When assessed separately, the presence of a secondary BSI with another infection increased the odds of recurrence over that infection without a BSI (aOR: 1.96, 95% CI: 1.68–2.30). Conclusion Approximately one in six persons with invasive MRSA infection had recurrence. We identified potential opportunities to prevent recurrence through infection control (e.g., management and early removal of central catheters). Other possible areas for preventing recurrence include improving the management of patients with BSI and bone/joint infections (including both during and after antibiotic treatment) and mitigating risk of infection from IDU. Disclosures All authors: No reported disclosures.

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Risk Factors Associated with Methicillin-Resistant Staphylococcus Aureus (Mrsa) Bacteremia in the United States

Value in Health ◽

10.1016/j.jval.2014.03.058 ◽

2014 ◽

Vol 17 (3) ◽

pp. A9

Author(s):

AM Pawar ◽

CJ Willey ◽

AR Caffrey

Keyword(s):

United States ◽

Risk Factors ◽

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

The United States ◽

Methicillin Resistant ◽

Factors Associated

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Risk Factors Associated With Methicillin-Resistant Staphylococcus aureus (MRSA) Complicated Skin and Soft Tissue Infection in Colombia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.870 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Sandra Liliana Valderrama Beltran ◽

Sandra Gualtero ◽

Jose Rodriguez ◽

Johanna Osorio ◽

Carlos Arturo Alvarez Moreno ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Soft Tissue ◽

Soft Tissue Infection ◽

Methicillin Resistant Staphylococcus Aureus ◽

Tissue Infection ◽

Methicillin Resistant ◽

Factors Associated ◽

Complicated Skin

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Incidence and risk factors for community-associated methicillin-resistant Staphylococcus aureus in New York City, 2006–2012

Epidemiology and Infection ◽

10.1017/s095026881500196x ◽

2015 ◽

Vol 144 (5) ◽

pp. 1014-1017 ◽

Cited By ~ 4

Author(s):

P. BAKER ◽

B. COHEN ◽

J. LIU ◽

E. LARSON

Keyword(s):

Risk Factors ◽

New York ◽

Staphylococcus Aureus ◽

New York City ◽

Logistic Regression ◽

York City ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Factors Associated ◽

History Of

SUMMARYThis study aims to describe changes in incidence and risk factors for community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) infections upon admission to two New York City hospitals from 2006 to 2012. We examined the first hospitalization for adult patients using electronic health record and administrative data and determined the annual incidence/1000 admissions of total S. aureus, total MRSA, and CA-MRSA (within 48 h of admission) in clinical specimens over the study period. Logistic regression was used to identify factors associated with CA-MRSA in 2006 and 2012. In 137 350 admissions, the incidence of S. aureus, MRSA, and CA-MRSA/1000 admissions were 15·6, 7·0, and 3·5, respectively. The total S. aureus and MRSA isolations decreased significantly over the study period (27% and 25%, respectively) while CA-MRSA incidence was unchanged. CA-MRSA increased as a proportion of all MRSA between 2006 (46%) and 2012 (62%), and was most frequently isolated from respiratory (1·5/1000) and blood (0·7/1000) cultures. Logistic regression analysis of factors associated with isolation of CA-MRSA showed that age ⩾65 years [odds ratio (OR) 2·3, 95% confidence interval (CI) 1·2–4·5], male gender (OR 1·8, 95% CI 1·2–2·8) and history of renal failure (OR 2·6, 95% CI 1·6–4·2) were significant predictors of infection in 2006. No predictors were identified in 2012.

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