Staphylococcus aureus bacteremia after thermal injury: The clinical impact of methicillin resistance

• Published in: Burns 2013-05, Vol.39 (3), p.404-412
• Main Authors: Theodorou, Panagiotis, Lefering, Rolf, Perbix, Walter, Spanholtz, Timo A, Maegele, Marc, Spilker, Gerald, Thamm, Oliver C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bacteremia; Bacteremia - microbiology; Bacteremia - mortality; BICU; Burn Units - statistics & numerical data; Burns; Burns - microbiology; Burns - mortality; Critical Care; Female; Hospital Mortality; Humans; Incidence; Length of stay; Length of Stay - statistics & numerical data; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mortality; MRSA; Retrospective Studies; Staphylococcal Infections - mortality; Staphylococcus aureus
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2012.12.006

Abstract Objective To evaluate the impact of methicillin resistance in Staphylococcus aureus bacteremia (SAB) on mortality and length of stay in burn patients. Design Retrospective cohort study. Setting A 750-bed tertiary care university hospital in Cologne, Germany. Patients Patients registered in the database of the burn intensive care unit (BICU) between 1989 and 2009 with complete data sets ( n = 1688). Results Over the 21-year study period, 74 patients with SAB were identified; 33 patients had methicillin-resistant S. aureus (MRSA) and 41 methicillin-susceptible S. aureus (MSSA). Comparing the MRSA with the MSSA population the following parameters were significantly different in the univariate analysis: BMI (27.2 kg/m2 vs. 23.6 kg/m2 ; P = 0.05), extent of deep partial thickness burns (17.8% vs. 9.0% of total body surface area; P = 0.007), antibiotic requirement on admission (45.5% vs. 22.0%; P = 0.046), median length of hospitalization prior SAB (24 days vs. 7 days; P < 0.001), packed red blood cells administration (47.6 units vs. 26.1 units; P = 0.003), intubation requirement (100% vs. 80.5%; P = 0.007), intubation period (43.5 days vs. 26.8 days; P = 0.008), catecholamine requirement (90.9% vs. 61.0%; P = 0.004), sepsis (60.6% vs. 34.1%; P = 0.035) and organ failures (81.8% vs. 39.0%; P < 0.001). Regarding outcome parameters, methicillin resistance was not significantly related with mortality (adjusted OR 1.55, 95% CI 0.56–4.28; P = 0.40) and length of BICU stay after SAB (Kaplan–Meier analysis log-rank test P = 0.32; Cox's proportional hazards regression HR 1.22, 95% CI 0.65–2.27, P = 0.535) in the univariate and multivariate analyses. Conclusion Our data suggest that methicillin resistance is not associated with significant increases in mortality and length of BICU stay among burn patients with SAB.