Methicillin-resistant staphylococcus aureus – Rokowania, prognozy i postęp choroby

Methicillin-resistant staphylococcus aureus
Rokowania, prognozy i postęp choroby

Zakażenia wywoływane przez MRSA stanowią istotne wyzwanie kliniczne ze względu na wysoką śmiertelność, szczególnie w przypadku bakteriemii, gdzie wskaźniki śmiertelności sięgają 20-50%. Ryzyko zgonu rośnie wraz z wiekiem pacjenta: 6,9% u osób <65 lat, 10,8% w wieku 65-80 lat oraz 33,2% u pacjentów >80 lat. Dodatkowo, czynniki takie jak choroby współistniejące (np. choroby serca, nowotwory), obecność cewnika moczowego, hipoalbuminemia oraz niewłaściwe leczenie antybiotykowe pogarszają rokowanie. Szczepy VISA, charakteryzujące się pośrednią opornością na wankomycynę, wykazują 30-dniową śmiertelność na poziomie 34%, co jest szczególnie niepokojące w kontekście ograniczonych opcji terapeutycznych. Różnice w rokowaniu obserwuje się także między HA-MRSA a CA-MRSA, przy czym zakażenia pozaszpitalne mają zwykle lepsze rokowanie, choć do 70% zakażeń skórnych MRSA nawraca.

MRSA – Methicillin-resistant staphylococcus aureus: Prognoza (rokowanie)

Wskaźniki śmiertelności w zakażeniach MRSA
Czynniki wpływające na rokowanie w zakażeniach MRSA
Rokowanie w zakażeniach szpitalnych i pozaszpitalnych
Rokowanie w zależności od genotypu MRSA
Długoterminowe rokowanie po zakażeniu MRSA
Rokowanie w specyficznych podtypach MRSA
Modele predykcyjne w prognozowaniu zakażeń MRSA
Rokowanie w sepsie MRSA
Podsumowanie rokowania w zakażeniach MRSA
Kolejne rozdziały

MRSA – Methicillin-resistant staphylococcus aureus: Prognoza (rokowanie)

Zakażenia wywoływane przez szczepy Methicillin-resistant Staphylococcus aureus (MRSA) stanowią poważne zagrożenie dla zdrowia publicznego, prowadząc do znacznej chorobowości i śmiertelności zarówno w środowisku szpitalnym, jak i pozaszpitalnym. Zakażenia te mogą występować w formie od bezobjawowej kolonizacji błony śluzowej nosa po łagodne infekcje skóry i tkanek miękkich, aż do piorunujących infekcji inwazyjnych o wysokiej śmiertelności.¹ Prawidłowa ocena rokowania w zakażeniach MRSA ma kluczowe znaczenie dla optymalizacji leczenia i podejmowania decyzji klinicznych.

Wskaźniki śmiertelności w zakażeniach MRSA

Badania dotyczące śmiertelności związanej z MRSA skupiają się głównie na ciężkich infekcjach, zwłaszcza bakteriemiach. Dane wskazują na zróżnicowane wskaźniki śmiertelności w zależności od wieku pacjenta, lokalizacji infekcji oraz czynników ryzyka.² Śmiertelność w bakteriemii MRSA szacowana jest na poziomie 20-50%, co czyni ją jedną z najpoważniejszych postaci zakażenia.³

Analizy 30-dniowej śmiertelności w zależności od wieku pacjentów wykazały wyraźnie rosnący trend związany z wiekiem:

Osoby poniżej 65 roku życia: 6,9%
Osoby w wieku 65-80 lat: 10,8%
Osoby powyżej 80 roku życia: 33,2%

⁴

W innym badaniu stwierdzono ogólny wskaźnik śmiertelności na poziomie 41,9%, z wyraźnie wyższą śmiertelnością wśród pacjentów powyżej 60 roku życia (49%) w porównaniu do młodszych pacjentów (32,4%).⁵ Szczególnie wysokie wskaźniki śmiertelności obserwowano w grupie wiekowej 85+ oraz 75-84 lata.⁶

Czynniki wpływające na rokowanie w zakażeniach MRSA

Oprócz wieku, zidentyfikowano liczne czynniki wpływające na rokowanie pacjentów z zakażeniami MRSA:⁷

Choroby współistniejące – choroby serca, nowotwory oraz inne schorzenia przewlekłe
Obecność cewnika moczowego
Brak odpowiedniej opieki medycznej – w tym brak konsultacji ze specjalistą chorób zakaźnych
Niewłaściwe leczenie – w tym nieodpowiedni dobór antybiotyków
Hipoalbuminemia – niskie stężenie albumin we krwi

⁸

Istnieją również dane sugerujące, że samo bezobjawowe nosicielstwo MRSA w jamie nosowej może zwiększać ryzyko śmiertelności, choć mechanizm tego zjawiska wymaga dalszych badań.⁹

Rokowanie w zakażeniach szpitalnych i pozaszpitalnych

Badania wykazują różnice w rokowaniu między zakażeniami MRSA nabytymi w środowisku szpitalnym (HA-MRSA) a pozaszpitalnym (CA-MRSA). Zakażenia CA-MRSA, zwłaszcza infekcje skórne, są zazwyczaj łatwiejsze w leczeniu niż HA-MRSA.¹⁰ Jednakże nawet po skutecznym leczeniu, do 70% zakażeń skórnych MRSA nawraca, co może być związane z kolonizacją MRSA u osób z bliskiego otoczenia pacjenta lub przetrwaniem bakterii na powierzchniach i przedmiotach.¹¹

Retrospektywne badanie prowadzone na Węgrzech wykazało, że 30-dniowa śmiertelność ogólna w przypadkach bakteriemii Staphylococcus aureus wynosiła 35,3%, przy czym wskaźniki były wyższe w przypadkach wywołanych przez MRSA (39,9%) w porównaniu do MSSA (30,7%, p<0,0001).¹² Wyższy wskaźnik śmiertelności w przypadkach MRSA może wynikać z większej oporności na antybiotyki, co prowadzi do częstszego stosowania nieodpowiedniej empirycznej antybiotykoterapii.¹³

Rokowanie w zależności od genotypu MRSA

Badania sugerują, że różne genotypy MRSA mogą być związane z różnym rokowaniem. W badaniu węgierskim zaobserwowano, że zakażenia wywołane przez izolaty SCCmec IV wiązały się z najwyższym wskaźnikiem śmiertelności (42,2%), mimo podobnych wskaźników chorób współistniejących u różnych grup pacjentów.¹⁴ Wyniki te sugerują, że rokowanie zakażenia jest determinowane przez oporność na antybiotyki, genotyp bakterii oraz czynniki związane z pacjentem, a nie przez czynniki wirulencji przenoszone przez bakterie.¹⁵

Długoterminowe rokowanie po zakażeniu MRSA

Badanie kohortowe wykazało znacznie zwiększoną śmiertelność w ciągu roku od rozpoznania MRSA w środowisku pozaszpitalnym. W ciągu roku od diagnozy 21,8% pacjentów z MRSA zmarło, w porównaniu do 5,0% pacjentów bez rozpoznania MRSA. Skorygowany współczynnik ryzyka zgonu wynosił 4,1 (95% przedział ufności: 3,5-4,7).¹⁶ Ta zwiększona śmiertelność nie może być całkowicie wyjaśniona przez choroby współistniejące, ponieważ analizy uwzględniały główne czynniki ryzyka zgonu.¹⁷

Bardzo wysoki wskaźnik śmiertelności obserwowany u pacjentów z MRSA, niezależny od wyjściowego stanu zdrowia, sugeruje, że MRSA może być potencjalnie poważnym zakażeniem w środowisku pozaszpitalnym, prowadzącym do zwiększonej śmiertelności.¹⁸

Rokowanie w specyficznych podtypach MRSA

Szczególnym powodem do niepokoju są szczepy Vancomycin-intermediate Staphylococcus aureus (VISA), które są wielolekoopornymi patogenami. Zakażenia VISA, zwłaszcza bakteriemie, wiążą się z wysoką śmiertelnością – 34% pacjentów umiera w ciągu 30 dni.¹⁹ Częstość występowania zakażeń VISA na oddziałach intensywnej terapii stale rośnie, przy czym ostatnie badania wskazują na wskaźniki od 2% do 10% wśród izolatów MRSA.²⁰ Jest to szczególnie alarmujące ze względu na ograniczone opcje leczenia dostępne dla zakażeń VISA.²¹

Modele predykcyjne w prognozowaniu zakażeń MRSA

Rozwijane są modele uczenia maszynowego i głębokiego do przewidywania wyników zakażeń MRSA, co może pomóc w stratyfikacji ryzyka i podejmowaniu decyzji dotyczących leczenia. Modele data mining wykazały wysoką dokładność predykcyjną:

82,0-86,6% dokładności dla 7-dniowej przetrwałości MRSA w posiewach krwi
91,2% dokładności dla 30-dniowej przetrwałości MRSA w posiewach krwi
53,4-69,2% dokładności dla śmiertelności 30-dniowej

²²²³

Model głębokiego uczenia PyTorch_EHR, wykorzystujący dane z elektronicznej dokumentacji medycznej (EHR), osiągnął wysoką skuteczność w przewidywaniu dodatnich posiewów MRSA w ciągu dwóch tygodni (AUROC=0,911), przewyższając tradycyjne modele uczenia maszynowego.²⁴ Model ten może przynieść korzyści w praktyce klinicznej poprzez zmniejszenie liczby antybiotyków stosowanych u pacjentów z niskim ryzykiem i zapewnienie optymalnych antybiotyków przeciwko MRSA, gdy model przewiduje wysokie ryzyko, w tym bakteriemię.²⁵

Również modele ekologicznej niszy geograficznej mogą przewidywać obszary o wysokim i niskim prawdopodobieństwie występowania CA-MRSA lub CA-MSSA, co może pomóc lokalnym agencjom zdrowia publicznego w zapobieganiu wybuchom epidemii S. aureus.²⁶

Rokowanie w sepsie MRSA

Sepsa wywołana przez MRSA charakteryzuje się szczególnie wysokimi wskaźnikami śmiertelności. Sepsa MRSA występująca w ciągu 30 dni po zakażeniu chirurgicznym ma wskaźnik śmiertelności 15-38%, natomiast sepsa MRSA występująca w ciągu roku ma wskaźnik śmiertelności około 55%.²⁷ Meta-analiza 31 badań przeprowadzona przez Cosgrove i wsp. wykazała, że bakteriemia MRSA wiąże się ze zwiększoną śmiertelnością w porównaniu z bakteriemią wywołaną przez metycylinowrażliwe S. aureus (MSSA).²⁸

Podsumowanie rokowania w zakażeniach MRSA

Rokowanie w zakażeniach MRSA jest zróżnicowane i zależy od wielu czynników, w tym:

Wieku pacjenta – najwyższa śmiertelność u osób starszych (powyżej 80 roku życia)
Lokalizacji zakażenia – bakteriemia ma najgorsze rokowanie
Pochodzenia zakażenia – szpitalne (HA-MRSA) vs pozaszpitalne (CA-MRSA)
Genotypu bakterii – szczepy SCCmec IV związane z wyższą śmiertelnością
Chorób współistniejących – obecność chorób przewlekłych pogarsza rokowanie
Oporności na antybiotyki – szczepy VISA charakteryzują się gorszym rokowaniem
Odpowiedniego leczenia – opóźnienie w rozpoczęciu właściwej antybiotykoterapii pogarsza rokowanie

²⁹³⁰

Chociaż ponad połowa wszystkich przypadków MRSA jest wyleczona antybiotykami, a większość zakażeń skóry MRSA jest skutecznie leczona, poważne infekcje takie jak zapalenie płuc, zapalenie wsierdzia i bakteriemia mogą szybko się pogarszać, zanim lekarz znajdzie skuteczne leczenie.³¹ Rozwój skutecznych modeli predykcyjnych oraz lepsze zrozumienie dynamiki kolonizacji, dróg przenoszenia, czynników ryzyka progresji do infekcji i warunków sprzyjających pojawianiu się oporności umożliwi optymalizację strategii skutecznej kontroli MRSA.³²

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Materiały źródłowe

#1 Methicillin-resistant Staphylococcus aureus | Nature Reviews Disease Primers
https://www.nature.com/articles/nrdp201833
Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged, disseminated globally and become a leading cause of bacterial infections in both health-care and community settings. […] Clinical manifestations of MRSA range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections to fulminant invasive disease with high mortality. […] An understanding of colonization dynamics, routes of transmission, risk factors for progression to infection and conditions that promote the emergence of resistance will enable optimization of strategies to effectively control MRSA. […] Although treatment options for MRSA are limited, several new antimicrobials are under development. […] This paper reveals how different S. aureus lineages have adopted different strategies to overcome host responses and cause severe pathology.
#2 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Severe MRSA infections can be fatal. MRSA mortality rates tend to be highest in older people. Certain underlying health conditions can also increase the risk of death. […] While MRSA can cause a mild skin infection in some people, in others, it can lead to serious illness and even death. Most of the research into MRSA survival and mortality focuses on these serious infections, namely bloodstream infections. […] The researchers found that the 30-day mortality rate increased with older age: under 65: 6.9%, 65 to 80: 10.8%, over 80: 33.2%. […] The researchers found an overall mortality rate of 41.9%. When they broke mortality rates down by age, participants older than 60 had a noticeably higher mortality rate (49%) than those younger than 60 (32.4%). […] However, it still pointed out that mortality rates were highest in the oldest age groups, specifically in people 85 and older. Those between 75 and 84 also had high mortality rates.
#3 MRSA: Causes, Symptoms, Diagnosis, Treatment & Prevention
https://my.clevelandclinic.org/health/diseases/11633-methicillin-resistant-staphylococcus-aureus-mrsa
If you have a skin infection, your provider will surgically treat and drain your wounds. They might give you topical or oral antibiotics. You’ll need to be treated in the hospital if you have a severe or invasive MRSA infection. […] CA-MRSA, especially skin infections, can be easier to treat than HA-MRSA. But up to 70% of MRSA skin infections come back (recur) after successful treatment. This might be because other people you live with or are around a lot are colonized with MRSA, or because MRSA lives on objects and surfaces for a long time, where it can reinfect you. […] Yes, more than half of all MRSA cases are cured with antibiotics, and providers successfully treat most MRSA skin infections. But serious infections like pneumonia, endocarditis and bacteremia can quickly get worse before a provider can find a treatment that works. […] The mortality (death) rate of MRSA depends on where you’re infected. For MRSA bacteremia one of the more serious forms the mortality rate is between 20% and 50%.
#4 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Severe MRSA infections can be fatal. MRSA mortality rates tend to be highest in older people. Certain underlying health conditions can also increase the risk of death. […] While MRSA can cause a mild skin infection in some people, in others, it can lead to serious illness and even death. Most of the research into MRSA survival and mortality focuses on these serious infections, namely bloodstream infections. […] The researchers found that the 30-day mortality rate increased with older age: under 65: 6.9%, 65 to 80: 10.8%, over 80: 33.2%. […] The researchers found an overall mortality rate of 41.9%. When they broke mortality rates down by age, participants older than 60 had a noticeably higher mortality rate (49%) than those younger than 60 (32.4%). […] However, it still pointed out that mortality rates were highest in the oldest age groups, specifically in people 85 and older. Those between 75 and 84 also had high mortality rates.
#5 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Severe MRSA infections can be fatal. MRSA mortality rates tend to be highest in older people. Certain underlying health conditions can also increase the risk of death. […] While MRSA can cause a mild skin infection in some people, in others, it can lead to serious illness and even death. Most of the research into MRSA survival and mortality focuses on these serious infections, namely bloodstream infections. […] The researchers found that the 30-day mortality rate increased with older age: under 65: 6.9%, 65 to 80: 10.8%, over 80: 33.2%. […] The researchers found an overall mortality rate of 41.9%. When they broke mortality rates down by age, participants older than 60 had a noticeably higher mortality rate (49%) than those younger than 60 (32.4%). […] However, it still pointed out that mortality rates were highest in the oldest age groups, specifically in people 85 and older. Those between 75 and 84 also had high mortality rates.
#6 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Severe MRSA infections can be fatal. MRSA mortality rates tend to be highest in older people. Certain underlying health conditions can also increase the risk of death. […] While MRSA can cause a mild skin infection in some people, in others, it can lead to serious illness and even death. Most of the research into MRSA survival and mortality focuses on these serious infections, namely bloodstream infections. […] The researchers found that the 30-day mortality rate increased with older age: under 65: 6.9%, 65 to 80: 10.8%, over 80: 33.2%. […] The researchers found an overall mortality rate of 41.9%. When they broke mortality rates down by age, participants older than 60 had a noticeably higher mortality rate (49%) than those younger than 60 (32.4%). […] However, it still pointed out that mortality rates were highest in the oldest age groups, specifically in people 85 and older. Those between 75 and 84 also had high mortality rates.
#7 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Mortality rates for MRSA, specifically MRSA bloodstream infections, are highest in older adults. […] In addition to age, several other factors can increase the risk of death from these infections. These include underlying health conditions like heart disease and cancer, as well as several factors related to the infection itself. […] A 2023 study reported that, in addition to older age, additional risk factors for 30-day mortality from an MRSA bloodstream infection were: having a urinary catheter, lack of quality medical care, such as a consultation from a hospital infectious disease team or inappropriate treatment, having hypoalbuminemia (low levels of albumin in the blood). […] Some evidence suggests just having MRSA in your nose without symptoms may increase mortality risk. […] The exact reason for this finding is unknown and requires additional research. […] While many people can recover from a mild MRSA infection, more severe infections are associated with higher mortality or may cause permanent organ damage that could negatively affect life expectancy.
#8 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Mortality rates for MRSA, specifically MRSA bloodstream infections, are highest in older adults. […] In addition to age, several other factors can increase the risk of death from these infections. These include underlying health conditions like heart disease and cancer, as well as several factors related to the infection itself. […] A 2023 study reported that, in addition to older age, additional risk factors for 30-day mortality from an MRSA bloodstream infection were: having a urinary catheter, lack of quality medical care, such as a consultation from a hospital infectious disease team or inappropriate treatment, having hypoalbuminemia (low levels of albumin in the blood). […] Some evidence suggests just having MRSA in your nose without symptoms may increase mortality risk. […] The exact reason for this finding is unknown and requires additional research. […] While many people can recover from a mild MRSA infection, more severe infections are associated with higher mortality or may cause permanent organ damage that could negatively affect life expectancy.
#9 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Mortality rates for MRSA, specifically MRSA bloodstream infections, are highest in older adults. […] In addition to age, several other factors can increase the risk of death from these infections. These include underlying health conditions like heart disease and cancer, as well as several factors related to the infection itself. […] A 2023 study reported that, in addition to older age, additional risk factors for 30-day mortality from an MRSA bloodstream infection were: having a urinary catheter, lack of quality medical care, such as a consultation from a hospital infectious disease team or inappropriate treatment, having hypoalbuminemia (low levels of albumin in the blood). […] Some evidence suggests just having MRSA in your nose without symptoms may increase mortality risk. […] The exact reason for this finding is unknown and requires additional research. […] While many people can recover from a mild MRSA infection, more severe infections are associated with higher mortality or may cause permanent organ damage that could negatively affect life expectancy.
#10 MRSA: Causes, Symptoms, Diagnosis, Treatment & Prevention
https://my.clevelandclinic.org/health/diseases/11633-methicillin-resistant-staphylococcus-aureus-mrsa
If you have a skin infection, your provider will surgically treat and drain your wounds. They might give you topical or oral antibiotics. You’ll need to be treated in the hospital if you have a severe or invasive MRSA infection. […] CA-MRSA, especially skin infections, can be easier to treat than HA-MRSA. But up to 70% of MRSA skin infections come back (recur) after successful treatment. This might be because other people you live with or are around a lot are colonized with MRSA, or because MRSA lives on objects and surfaces for a long time, where it can reinfect you. […] Yes, more than half of all MRSA cases are cured with antibiotics, and providers successfully treat most MRSA skin infections. But serious infections like pneumonia, endocarditis and bacteremia can quickly get worse before a provider can find a treatment that works. […] The mortality (death) rate of MRSA depends on where you’re infected. For MRSA bacteremia one of the more serious forms the mortality rate is between 20% and 50%.
#11 MRSA: Causes, Symptoms, Diagnosis, Treatment & Prevention
https://my.clevelandclinic.org/health/diseases/11633-methicillin-resistant-staphylococcus-aureus-mrsa
If you have a skin infection, your provider will surgically treat and drain your wounds. They might give you topical or oral antibiotics. You’ll need to be treated in the hospital if you have a severe or invasive MRSA infection. […] CA-MRSA, especially skin infections, can be easier to treat than HA-MRSA. But up to 70% of MRSA skin infections come back (recur) after successful treatment. This might be because other people you live with or are around a lot are colonized with MRSA, or because MRSA lives on objects and surfaces for a long time, where it can reinfect you. […] Yes, more than half of all MRSA cases are cured with antibiotics, and providers successfully treat most MRSA skin infections. But serious infections like pneumonia, endocarditis and bacteremia can quickly get worse before a provider can find a treatment that works. […] The mortality (death) rate of MRSA depends on where you’re infected. For MRSA bacteremia one of the more serious forms the mortality rate is between 20% and 50%.
#12 Characterisation of antibiotic resistance, virulence, clonality and mortality in MRSA and MSSA bloodstream infections at a tertiary-level hospital in Hungary: a 6-year retrospective study | Annals of Clinical Microbiology and Antimicrobials | Full Text
https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-020-00357-z
Staphylococcus aureus bloodstream infections (BSI) cause significant morbidity and mortality due to the frequent antibiotic resistance, toxin and adhesin production of the bacterium. […] Infections caused by SCCmec IV isolates were associated with the highest mortality rate (42.2%), despite the similar comorbidity rates of the different patient groups. All-cause 30-day mortality was 39.9% in the MRSA and 30.7% in the MSSA group. […] This study provides insight into the clonal composition and associated mortality of BSI Staphylococcus aureus isolates in Hungary. The results suggest that the outcome of the infection is determined by the antibiotic resistance, genotype of the bacterium, and patient-related factors; rather than the virulence factors carried by the bacteria. […] Overall 30-day mortality was 35.3% in our BSI Staphylococcus aureus cases, with higher rates in BSI cases caused by MRSA (39.9% vs 30.7% in MSSA, respectively, p<0.0001), although CCI did not differ significantly in the 2 groups.
#13 Characterisation of antibiotic resistance, virulence, clonality and mortality in MRSA and MSSA bloodstream infections at a tertiary-level hospital in Hungary: a 6-year retrospective study | Annals of Clinical Microbiology and Antimicrobials | Full Text
https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-020-00357-z
Higher antibiotic resistance of MRSA isolates may be an explanation for high mortality rates, as inappropriate empirical antibiotic therapy is described to be more frequent in patients with MRSA bacteraemia. […] Our findings suggest that the outcome of the infection is related to the antibiotic resistance and clonality of the bacterium and to patient-related factors, such as age and gender, rather than the virulence factors of the bacteria. […] In conclusion, antibiotic resistance and virulence of MRSA and MSSA isolates differ significantly. In our population, higher 30-day mortality was associated with BSI caused by MRSA and by strains with high teicoplanin MIC value.
#14 Characterisation of antibiotic resistance, virulence, clonality and mortality in MRSA and MSSA bloodstream infections at a tertiary-level hospital in Hungary: a 6-year retrospective study | Annals of Clinical Microbiology and Antimicrobials | Full Text
https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-020-00357-z
Staphylococcus aureus bloodstream infections (BSI) cause significant morbidity and mortality due to the frequent antibiotic resistance, toxin and adhesin production of the bacterium. […] Infections caused by SCCmec IV isolates were associated with the highest mortality rate (42.2%), despite the similar comorbidity rates of the different patient groups. All-cause 30-day mortality was 39.9% in the MRSA and 30.7% in the MSSA group. […] This study provides insight into the clonal composition and associated mortality of BSI Staphylococcus aureus isolates in Hungary. The results suggest that the outcome of the infection is determined by the antibiotic resistance, genotype of the bacterium, and patient-related factors; rather than the virulence factors carried by the bacteria. […] Overall 30-day mortality was 35.3% in our BSI Staphylococcus aureus cases, with higher rates in BSI cases caused by MRSA (39.9% vs 30.7% in MSSA, respectively, p<0.0001), although CCI did not differ significantly in the 2 groups.
#15 Characterisation of antibiotic resistance, virulence, clonality and mortality in MRSA and MSSA bloodstream infections at a tertiary-level hospital in Hungary: a 6-year retrospective study | Annals of Clinical Microbiology and Antimicrobials | Full Text
https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-020-00357-z
Higher antibiotic resistance of MRSA isolates may be an explanation for high mortality rates, as inappropriate empirical antibiotic therapy is described to be more frequent in patients with MRSA bacteraemia. […] Our findings suggest that the outcome of the infection is related to the antibiotic resistance and clonality of the bacterium and to patient-related factors, such as age and gender, rather than the virulence factors of the bacteria. […] In conclusion, antibiotic resistance and virulence of MRSA and MSSA isolates differ significantly. In our population, higher 30-day mortality was associated with BSI caused by MRSA and by strains with high teicoplanin MIC value.
#16 Mortality after infection with methicillin-resistant Staphylococcus aureus (MRSA) diagnosed in the community
https://pmc.ncbi.nlm.nih.gov/articles/PMC2259374/
Outbreak reports suggest that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections can be life-threatening. […] The cohort included 1439 patients diagnosed with MRSA and 14,090 patients with no MRSA diagnosis. Mean age at cohort entry was 70 years in both groups, while co-morbid conditions were more prevalent in the patients with MRSA. Within 1 year, 21.8% of MRSA patients died as compared with 5.0% of non-MRSA patients. The risk of death was increased in patients diagnosed with MRSA in the community (adjusted hazard ratio 4.1; 95% confidence interval: 3.54.7). […] MRSA infections diagnosed in the community are associated with significant mortality in the year after diagnosis. […] In this study, we demonstrated an increase in mortality within a year of a diagnosis with an MRSA infection in the community. This increased mortality cannot be completely explained by underlying co-morbid conditions as we adjusted for the major risk factors of death. The four-fold increase in mortality persisted across several sensitivity analyses.
#17 Mortality after infection with methicillin-resistant Staphylococcus aureus (MRSA) diagnosed in the community
https://pmc.ncbi.nlm.nih.gov/articles/PMC2259374/
Outbreak reports suggest that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections can be life-threatening. […] The cohort included 1439 patients diagnosed with MRSA and 14,090 patients with no MRSA diagnosis. Mean age at cohort entry was 70 years in both groups, while co-morbid conditions were more prevalent in the patients with MRSA. Within 1 year, 21.8% of MRSA patients died as compared with 5.0% of non-MRSA patients. The risk of death was increased in patients diagnosed with MRSA in the community (adjusted hazard ratio 4.1; 95% confidence interval: 3.54.7). […] MRSA infections diagnosed in the community are associated with significant mortality in the year after diagnosis. […] In this study, we demonstrated an increase in mortality within a year of a diagnosis with an MRSA infection in the community. This increased mortality cannot be completely explained by underlying co-morbid conditions as we adjusted for the major risk factors of death. The four-fold increase in mortality persisted across several sensitivity analyses.
#18 Mortality after infection with methicillin-resistant Staphylococcus aureus (MRSA) diagnosed in the community
https://pmc.ncbi.nlm.nih.gov/articles/PMC2259374/
The death rate among the disease-free patients is broadly consistent for this age and sex distribution with that seen in UK vital statistics. […] The very high mortality rate seen in patients with MRSA in the present study, independent of baseline health status, is also highly suggestive of infections rather than carrier status. […] In conclusion, our study suggests that MRSA can be a potentially serious infection in the community leading to increased mortality.
#19 Data Mining Models in Prediction of Vancomycin-Intermediate Staphylococcus aureus in Methicillin-Resistant S. aureus (MRSA) Bacteremia Patients in a Clinical Care Setting
https://www.mdpi.com/2076-2607/13/1/101
Vancomycin-intermediate Staphylococcus aureus (VISA) is a multi-drug-resistant pathogen of significant clinical concern. […] VISA infections, particularly bacteremia, are associated with high mortality rates, with 34% of patients succumbing within 30 days. […] The resulting models demonstrated high predictive accuracy, with 82.0â86.6% accuracy for 7-day VISA persistence in blood cultures and 53.4â69.2% accuracy for 30-day mortality. […] These findings suggest that data mining techniques can effectively predict VISA bacteremia outcomes in clinical settings. […] The predictive models developed have the potential to be applied prospectively in hospital settings, aiding in risk stratification and informing treatment decisions. […] The prevalence of VISA infections in ICUs has been steadily increasing, with recent studies reporting rates ranging from 2% to 10% among methicillin-resistant Staphylococcus aureus (MRSA) isolates.
#20 Data Mining Models in Prediction of Vancomycin-Intermediate Staphylococcus aureus in Methicillin-Resistant S. aureus (MRSA) Bacteremia Patients in a Clinical Care Setting
https://www.mdpi.com/2076-2607/13/1/101
Vancomycin-intermediate Staphylococcus aureus (VISA) is a multi-drug-resistant pathogen of significant clinical concern. […] VISA infections, particularly bacteremia, are associated with high mortality rates, with 34% of patients succumbing within 30 days. […] The resulting models demonstrated high predictive accuracy, with 82.0â86.6% accuracy for 7-day VISA persistence in blood cultures and 53.4â69.2% accuracy for 30-day mortality. […] These findings suggest that data mining techniques can effectively predict VISA bacteremia outcomes in clinical settings. […] The predictive models developed have the potential to be applied prospectively in hospital settings, aiding in risk stratification and informing treatment decisions. […] The prevalence of VISA infections in ICUs has been steadily increasing, with recent studies reporting rates ranging from 2% to 10% among methicillin-resistant Staphylococcus aureus (MRSA) isolates.
#21 Data Mining Models in Prediction of Vancomycin-Intermediate Staphylococcus aureus in Methicillin-Resistant S. aureus (MRSA) Bacteremia Patients in a Clinical Care Setting
https://www.mdpi.com/2076-2607/13/1/101
This rise is particularly alarming given the limited treatment options available for VISA infections and the high mortality rates associated with VISA bacteremia, which can exceed 30% within 30 days of infection onset. […] Our study found that out of 16 patients confirmed with VISA, 6 did not show persistence of S. aureus in blood cultures 7-day and 30-day post-initiation of vancomycin treatment. […] The risk factors used for input are not laboratory-related and can be readily available during antibiotics administration. […] Based on our results, we can predict the 7-day persistence of MRSA in blood cultures with an accuracy ranging from 82.0% to 86.6%, 30-day persistence of MRSA in blood cultures with an accuracy of 91.2%, and patient death within 30 days with an accuracy ranging from 53.4% to 69.2%.
#22 Data Mining Models in Prediction of Vancomycin-Intermediate Staphylococcus aureus in Methicillin-Resistant S. aureus (MRSA) Bacteremia Patients in a Clinical Care Setting
https://www.mdpi.com/2076-2607/13/1/101
This rise is particularly alarming given the limited treatment options available for VISA infections and the high mortality rates associated with VISA bacteremia, which can exceed 30% within 30 days of infection onset. […] Our study found that out of 16 patients confirmed with VISA, 6 did not show persistence of S. aureus in blood cultures 7-day and 30-day post-initiation of vancomycin treatment. […] The risk factors used for input are not laboratory-related and can be readily available during antibiotics administration. […] Based on our results, we can predict the 7-day persistence of MRSA in blood cultures with an accuracy ranging from 82.0% to 86.6%, 30-day persistence of MRSA in blood cultures with an accuracy of 91.2%, and patient death within 30 days with an accuracy ranging from 53.4% to 69.2%.
#23 Data Mining Models in Prediction of Vancomycin-Intermediate Staphylococcus aureus in Methicillin-Resistant S. aureus (MRSA) Bacteremia Patients in a Clinical Care Setting
https://www.mdpi.com/2076-2607/13/1/101
The strength of our approach lies in its ability to utilize readily available clinical information, avoiding the delays associated with traditional laboratory-based diagnostics. […] Our findings reveal impressive predictive accuracies: 82.0% to 86.6% for 7-day persistence, 91.2% for 30-day persistence, and 53.4% to 69.2% for 30-day mortality. […] These results underscore the potential of data mining approaches to enhance clinical decision-making in managing MRSA bacteremia and potential VISA cases.
#24 Deep learning model for personalized prediction of positive MRSA culture using time-series electronic health records | Nature Communications
https://www.nature.com/articles/s41467-024-46211-0
Methicillin-resistant Staphylococcus aureus (MRSA) poses significant morbidity and mortality in hospitals. Rapid, accurate risk stratification of MRSA is crucial for optimizing antibiotic therapy. Our study introduced a deep learning model, PyTorch_EHR, which leverages electronic health record (EHR) time-series data, including wide-variety patient specific data, to predict MRSA culture positivity within two weeks. […] PyTorch_EHR outperforms logistic regression (LR) and light gradient boost machine (LGBM) models in accuracy (AUROCPyTorch_EHR=0.911, AUROCLR=0.857, AUROCLGBM=0.892). […] Our model effectively stratifies patients into high-, medium-, and low-risk categories, potentially optimizing antimicrobial therapy and reducing unnecessary MRSA-specific antimicrobials. This highlights the advantage of deep learning models in predicting MRSA positive cultures, surpassing traditional machine learning models and supporting clinicians judgments.
#25 Deep learning model for personalized prediction of positive MRSA culture using time-series electronic health records | Nature Communications
https://www.nature.com/articles/s41467-024-46211-0
Our deep learning-based MRSA-predictive model exhibited better performance compared to other machine learning models in real-world MHHS and MIMIC-IV datasets. […] The model maintained better predictions even after transferring from the MHHS dataset to the MIMIC-IV dataset and tolerated the significantly imbalanced outcomes in the MIMIC-IV dataset. […] Our model could benefit clinical practice by reducing the number of antimicrobials used in low-risk patients and providing optimal MRSA antimicrobials when the model predicts high risk, including bacteremia. […] The high-risk patient population had a significantly high relative risk ratio for MRSA bacteremia. This indicates that our model predicts not only the positivity of MRSA culture but also the severity of MRSA infections in high-risk patients.
#26 Machine learning to predict risk for community-onset Staphylococcus aureus infections in children living in southeastern United States | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290375
Staphylococcus aureus (S. aureus) is known to cause human infections and since the late 1990s, community-onset antibiotic resistant infections (methicillin resistant S. aureus (MRSA)) continue to cause significant infections in the United States. […] Machine learning accurately predicts which densely populated areas are at highest and lowest risk for community-onset S. aureus infections over a 14-year time span. […] Our study indicated that densely populated areas was the single largest predictive variable for CO-MRSA and CO-MSSA occurrences. […] The geographic location plays an essential role in predicting risk for CO-S. aureus infections. […] Our MaxEnt models are able to generate accurate maps which predict areas with high to low probability of having CO-MRSA or CO-MSSA occurrence. […] Predicted risk areas based on the ecological niche model distribution of CO-MRSA occurrences highlights to local public health agencies how and to what extent more frequent surveillance is necessary in order to prevent S. aureus outbreaks from occurring.
#27 Methicillin-resistant Staphylococcus aureus – Wikipedia
https://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths worldwide attributable to antimicrobial resistance in 2019. […] After 72 hours, MRSA can take hold in human tissues and eventually become resistant to treatment. […] Generally, those infected by MRSA stay infected for just under 10 days, if treated by a doctor, although effects may vary from person to person. […] MRSA sepsis that occurs within 30 days following a surgical infection has a 1538% mortality rate; MRSA sepsis that occurs within one year has a mortality rate of around 55%. […] The observed increased mortality among MRSA-infected people arguably may be the result of the increased underlying morbidity of these people. […] In a meta-analysis of 31 studies, Cosgrove et al. concluded that MRSA bacteremia is associated with increased mortality as compared with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.
#28 Methicillin-resistant Staphylococcus aureus – Wikipedia
https://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths worldwide attributable to antimicrobial resistance in 2019. […] After 72 hours, MRSA can take hold in human tissues and eventually become resistant to treatment. […] Generally, those infected by MRSA stay infected for just under 10 days, if treated by a doctor, although effects may vary from person to person. […] MRSA sepsis that occurs within 30 days following a surgical infection has a 1538% mortality rate; MRSA sepsis that occurs within one year has a mortality rate of around 55%. […] The observed increased mortality among MRSA-infected people arguably may be the result of the increased underlying morbidity of these people. […] In a meta-analysis of 31 studies, Cosgrove et al. concluded that MRSA bacteremia is associated with increased mortality as compared with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.
#29 MRSA Survival Rate by Age, and Factors that Affect Survival
https://www.healthline.com/health/infection/mrsa-survival-rate-by-age
Mortality rates for MRSA, specifically MRSA bloodstream infections, are highest in older adults. […] In addition to age, several other factors can increase the risk of death from these infections. These include underlying health conditions like heart disease and cancer, as well as several factors related to the infection itself. […] A 2023 study reported that, in addition to older age, additional risk factors for 30-day mortality from an MRSA bloodstream infection were: having a urinary catheter, lack of quality medical care, such as a consultation from a hospital infectious disease team or inappropriate treatment, having hypoalbuminemia (low levels of albumin in the blood). […] Some evidence suggests just having MRSA in your nose without symptoms may increase mortality risk. […] The exact reason for this finding is unknown and requires additional research. […] While many people can recover from a mild MRSA infection, more severe infections are associated with higher mortality or may cause permanent organ damage that could negatively affect life expectancy.
#30 Characterisation of antibiotic resistance, virulence, clonality and mortality in MRSA and MSSA bloodstream infections at a tertiary-level hospital in Hungary: a 6-year retrospective study | Annals of Clinical Microbiology and Antimicrobials | Full Text
https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-020-00357-z
Higher antibiotic resistance of MRSA isolates may be an explanation for high mortality rates, as inappropriate empirical antibiotic therapy is described to be more frequent in patients with MRSA bacteraemia. […] Our findings suggest that the outcome of the infection is related to the antibiotic resistance and clonality of the bacterium and to patient-related factors, such as age and gender, rather than the virulence factors of the bacteria. […] In conclusion, antibiotic resistance and virulence of MRSA and MSSA isolates differ significantly. In our population, higher 30-day mortality was associated with BSI caused by MRSA and by strains with high teicoplanin MIC value.
#31 MRSA: Causes, Symptoms, Diagnosis, Treatment & Prevention
https://my.clevelandclinic.org/health/diseases/11633-methicillin-resistant-staphylococcus-aureus-mrsa
If you have a skin infection, your provider will surgically treat and drain your wounds. They might give you topical or oral antibiotics. You’ll need to be treated in the hospital if you have a severe or invasive MRSA infection. […] CA-MRSA, especially skin infections, can be easier to treat than HA-MRSA. But up to 70% of MRSA skin infections come back (recur) after successful treatment. This might be because other people you live with or are around a lot are colonized with MRSA, or because MRSA lives on objects and surfaces for a long time, where it can reinfect you. […] Yes, more than half of all MRSA cases are cured with antibiotics, and providers successfully treat most MRSA skin infections. But serious infections like pneumonia, endocarditis and bacteremia can quickly get worse before a provider can find a treatment that works. […] The mortality (death) rate of MRSA depends on where you’re infected. For MRSA bacteremia one of the more serious forms the mortality rate is between 20% and 50%.
#32 Methicillin-resistant Staphylococcus aureus | Nature Reviews Disease Primers
https://www.nature.com/articles/nrdp201833
Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged, disseminated globally and become a leading cause of bacterial infections in both health-care and community settings. […] Clinical manifestations of MRSA range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections to fulminant invasive disease with high mortality. […] An understanding of colonization dynamics, routes of transmission, risk factors for progression to infection and conditions that promote the emergence of resistance will enable optimization of strategies to effectively control MRSA. […] Although treatment options for MRSA are limited, several new antimicrobials are under development. […] This paper reveals how different S. aureus lineages have adopted different strategies to overcome host responses and cause severe pathology.