845. ¨Staphylococccus aureus Bloodstream Infections in Latin America: Results of a Large Multinational Cohort Study¨
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • 845_IDSA_SEAS.pdf (538.5 kB)
  • Background: Staphylococcus aureus(Sa) bloodstream infections (BSI) are an important cause of morbidity and mortality worldwide. However, a comprehensive evaluation of the clinical impact of these infections has not been performed in Latin America (LA). We conducted a multinational prospective study of Sa-BSI to compare 30-day attributable mortality between MRSA and MSSA. 

    Methods: A cohort study, with 84-days of follow-up was conducted in nine LA countries. Bivariate and multivariate analyses were carried-out to evaluate differences in 30-day attributable mortality comparing MRSA and MSSA. Cox proportional hazards regression model was used to evaluate differences in survival. Multivariate analysis was adjusted for age, sex, comorbidities, Charlson index score, source of BSI, Pitt bacteremia score, complicated bacteremia and hospital.

    Results: A total of 921 Sa-BSI were included (126 in Argentina, 146 in Brazil, 134 in Chile, 129 in Colombia, 71 in Ecuador, 118 in Guatemala, 19 in Mexico, 150 in Peru and 28 in Venezuela). The prevalence of MRSA was 45%. Both MRSA and MSSA were more frequently acquired in hospitals. Patients with MRSA-BSI had more frequently previous Sa infections (7% vs. 3%, p=0.014); previous MRSA infections (4% vs. 1%, p=0005); previous use of antimicrobials (57% vs. 24%, p<0.001); severe sepsis (22% vs. 15%, p=0.007); and higher Pitt bacteremia scores >1 (46% vs. 37%, p=0.013), but had similar median Charlson comorbidity index scores (2 vs. 2, p=0.485) compared to MSSA.  MRSA-BSI was associated with higher 30-day attributable mortality [RR: 1.3 (1.1-1.6), p=0.002 compared to MSSA in the multivariate analysis. The Cox regression showed also higher mortality for BSI-MRSA [HR: 1.9 (1.3-2.7), p=0.002] compared to MSSA. Median duration of hospital stay was longer for MRSA-BSI compared to MSSA (28 vs. 20 days, p<0.001). Antimicrobial treatment was more properly given to MRSA-BSI than to MSSA (79% vs. 48%, p<0.001). No vancomycin resistance or hetero-resistance was observed.

    Conclusion: BSI-MRSA is associated with higher 30-day attributable mortality and longer hospital stay compared to MSSA in LA. Infectious disease consultation should be reinforced in LA to improve Sa-BSI outcomes.

    Carlos Seas, MD, FIDSA1, Coralith Garcia, MD1,2, Mauro Costa Salles, MD3, Jaime Labarca, MD4, Carlos Alvarez, MD, FIDSA5, Carlos Luna, MD6, Carlos Mejia, MD7, Jeannnete Zurita, MD8,9, Manuel Guzman-Blanco, MD10,11, Eduardo Rodriguez-Noriega, MD12, Jinnethe Reyes, PhD13, Cesar Arias, MD, PhD, FIDSA14, Cesar Carcamo, MD, PhD15, Eduardo Gotuzzo, MD, FIDSA16 and Latin American Working Group on Antimicrobial Resistance, (1)Hospital Cayetano Heredia, Lima, Peru, (2)Universidad Peruana Cayetano Heredia, Lima, Peru, (3)Division of Infectious Diseases, Santa Casa de Sao Paulo School of Medicine, Sao Paulo, Brazil, (4)Department of Infectious Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile, (5)Pontificia Universidad Javeriana, Bogota, Colombia, (6)Pulmonary Division, Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina, (7)Hospital Roosevelt, Guatemala, Guatemala, (8)Hospital Vozandes, Quito, Ecuador, (9)Facultad De Medicina, Pontificia Universidad Católica de Ecuador, Quito, Ecuador, (10)Hospital Vargas de Caracas, Caracas, Venezuela, (11)Centro Médico de Caracas, Caracas, Venezuela, (12)Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico, (13)Universidad El Bosque, Bogota, Colombia, (14)University of Texas Medical School at Houston, Houston, TX, (15)Epidemiology, HIV and STD Unit, University of Cayetano Heredia, Lima, Peru, (16)Instituto De Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru

    Disclosures:

    C. Seas, Pfizer: Grant Investigator , Research grant
    Glaxo Smith Kline and Beechan: Grant Investigator , Research grant

    C. Garcia, Pfizer: Grant Investigator , Research grant
    Sanofi Pasteur: Grant Investigator , Research grant

    M. Costa Salles, None

    J. Labarca, Pfizer: Board Member and Grant Investigator , Consulting fee and Research grant
    Wyeth: Grant Investigator , Research grant
    Sanofi Pasteur: Grant Investigator , Research grant
    Merck Sharp and Dohme: Board Member , Consulting fee
    Novartis: Board Member , Consulting fee

    C. Alvarez, Pfizer: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
    Merck Sharp and Dohme: Speaker's Bureau , Speaker honorarium
    Glaxo Smith Kline Beechan: Speaker's Bureau , Speaker honorarium
    Astra Zeneca: Speaker's Bureau , Speaker honorarium

    C. Luna, None

    C. Mejia, None

    J. Zurita, None

    M. Guzman-Blanco, Pfizer: Board Member and Investigator , Consulting fee and Grant recipient
    Astra Zeneca: Grant Investigator , Grant recipient
    Merck Sharp and Dohme: Board Member and Grant Investigator , Consulting fee and Research grant
    Beckton Dickinson: Board Member , Consulting fee

    E. Rodriguez-Noriega, None

    J. Reyes, None

    C. Arias, Pfizer: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
    Merck Sharp and Dohme: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
    Cubist: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
    Theravance: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
    Bayer: Consultant , Consulting fee

    C. Carcamo, None

    E. Gotuzzo, 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.