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Mortality among Patients with Methicillin-Resistant Staphylococcus aureus USA300 versus Non-USA300 Invasive Infections: A Meta-Analysis

Published online by Cambridge University Press:  10 May 2016

Rajeshwari Nair ,
Eric Ammann ,
Matthew Rysavy  and
Marin L. Schweizer
Rajeshwari Nair*
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Eric Ammann
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Matthew Rysavy
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
*
601 Highway 6 West, Mailstop 152, Iowa City VA Health Care System, Iowa City, IA 52246 (rajeshwari-nair@uiowa.edu)
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Abstract

Background.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been found to be epidemiologically and microbiologically distinct from healthcare-associated MRSA. Most CA-MRSA infections are not invasive; however, fatal outcomes have been reported among healthy people with CA-MRSA invasive infections. Epidemiological studies have attributed a major burden of CA-MRSA infections in the United States to the predominant clone USA300. We investigated the association between USA300 invasive infections and mortality by conducting a systematic review and meta-analysis of studies that reported mortality rates associated with USA300 strains.

Methods.

We searched PubMed, bibliographies of other publications, and gray literature between January 2001 and December 2013. Observational studies of patients with an invasive MRSA infection were included. The exposure of interest was presence of USA300 invasive infection. Studies were included only if they provided MRSA PFGE types and if corresponding mortality data were the measured outcome. We pooled crude odds ratios (cORs) using a random-effects model. Woolf test of homogeneity and Q and I2 statistics were assessed.

Results.

Of 574 articles identified by the search strategy, 8 met the inclusion criteria. Risk of mortality was significantly lower among patients with USA300 MRSA infections (pooled cOR, 0.63 [95% confidence interval (CI)], 0.49–0.81). There was a moderate degree of heterogeneity among study results (P = .29; I2 = 18%). Results were observed to be heterogeneous due to study design, quality of studies, and definition of mortality.

Conclusions.

MRSA invasive infection with USA300 does not appear to be associated with higher mortality compared with infections due to non-USA300 strains. Nevertheless, larger well-designed studies are warranted to further evaluate this association.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 1 , January 2014 , pp. 31 - 41
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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