1115. A Comparative Epidemiology of Methicillin-Resistant Staphylococcus aureus Infections in a Low Versus High Prevalence Country
Session: Poster Abstract Session: MRSA/VRE Epidemiology
Friday, October 9, 2015
Room: Poster Hall
  • IDweekPoster.pdf (1.4 MB)
  • Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major organism that causes a wide range of infections. Multiple studies have shown a diverse global epidemiology of MRSA with varying risk factors and infection sequelae. The purpose of this study is to compare the risk factors and outcomes of MRSA in a low prevalence (Lebanon) versus a high prevalence (Staten Island, New York) country.

    Methods: This is a case-case-control study conducted across two major tertiary care hospitals in Lebanon and New York between 2004 and 2014. In both centers, patients were divided into three groups. The first group comprised patients infected with MRSA strains, while the second group consisted of patients infected with methicillin-sensitive S. aureus (MSSA) strains. The control group contained patients who were hospitalized during the same time as cases but did not develop any infection. Using logistic regression, two multivariable models were constructed. By contrasting these models, variables uniquely associated with the isolation of MRSA were determined.

    Results: A total 519 patients were analyzed across both centers (318 in New York, 174 in Lebanon). In New York, infections were predominantly community acquired (76%) compared to the Lebanese cohort (49%). In the first multivariable model (MRSA vs. uninfected controls), recent placement of a central venous catheter (CVC) represented a strong risk factor for infection (OR 80.6; 95% CI 2.16-3014.1) among New York patients. In contrast, diabetes mellitus (OR 8.3; 95% CI 1.8-38.4) was associated with a higher risk of infection among Lebanese patients.  In the second multivariable model (MSSA vs uninfected controls), recent hospital stay >3 days was an independent predictor of infection in both Lebanon (OR 3.5; 95% CI 1.4-9.3) and New York (OR 4.1; 95% CI 1.04-15.8). Furthermore, patients local to New York were more likely to develop persistent bacteremia (p<.001), recurrence (p<.05), and other hospital acquired infections (p<.05). 

    Conclusion: Diabetes mellitus seems to be a unique risk factor to acquiring an MRSA infection in Lebanon, while the recent use of a CVC was robustly associated with MRSA infections in New York. In both patient populations, prior use of antibiotics did not predispose to a higher risk of infection. In New York only, patients infected with MRSA fared worse compared to those infected with MSSA.

    Mohamad Yasmin, MD1, Ambreen Khalil, MD2, Halim El Hage, MD1, Rita Obeid, M.A3, Salma Jabak, MD4, Tania Baban, MD4, Hanin El Haddad, MD1, Nisreen Sidani, RN, MSN4, Mazen Zaarour, MD1, Elias Fares, MD1, Ziad Esper, MD1, Souha Kanj, MD, FIDSA4 and Zeina Kanafani, MD4, (1)Internal Medicine, Staten Island University Hospital, Staten Island, NY, (2)Infectious Disease, Medicine, Staten Island University Hospital, Staten Island, NY, (3)The Graduate Center, CUNY, New York, NY, (4)American University of Beirut Medical Center, Beirut, Lebanon


    M. Yasmin, None

    A. Khalil, None

    H. El Hage, None

    R. Obeid, None

    S. Jabak, None

    T. Baban, None

    H. El Haddad, None

    N. Sidani, None

    M. Zaarour, None

    E. Fares, None

    Z. Esper, None

    S. Kanj, None

    Z. Kanafani, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.