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Staphylococcus aureus bloodstream infections in Latin America: results of a multinational prospective cohort study

2017; Oxford University Press; Volume: 73; Issue: 1 Linguagem: Inglês

10.1093/jac/dkx350

1460-2091

Carlos Seas, Coralith García, Mauro José Costa Salles, Jaime Labarca, Carlos M. Luna, Carlos Álvarez, Carlos Mejía-Villatoro, Jeannete Zurita, Manuel Guzmán-Blanco, Eduardo Rodríguez-Noriega, Jinnethe Reyes, César A. Arias, César Cárcamo, Eduardo Gotuzzo, Didier Bruno, Ernesto Efrón, Marcelo Del Castillo, Sanatorio Mater Dei, Thaís Guimarães, María Elena Ceballos, Escuela de Medicina, I Juanes Dominguez, Daniela Beltrán, Gisela Riedel, Sandra Valderrama, Sandra Milena Gualtero, Clínica Shaio, Carlos Saavedra, Facultad De Medicina, Juan Carlos Aragón, F. M. Godoy Guerrero, María Mónica Silvestre, Rayo Morfín‐Otero, Fray Antonio Alcalde, José Miguel Hidalgo Oviedo, Luis Hercilla, Ana María Cáceres Hernández, Marisela Silva, Alfonso José Guzmán,

Streptococcal Infections and Treatments

Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries.To assess the clinical impact of SAB in Latin America.We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model.A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P < 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P = 0.616] or in a sensitivity analysis using 30 day all-cause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P = 0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with β-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P = 0.602).MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.