Epidemiology of Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus infections in Lebanon

Farah Abou-Zeid; Sara C. Mourani; jamil M. Kazma; Amal Gharamti; Mohamad Yasmin; Salma Jabak; Tania Baban; Nisreen Sidani; Zeina A. Kanafani

doi:10.54034/mic.e1692

Authors

Farah Abou-Zeid Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
Sara C. Mourani Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
jamil M. Kazma Department of Obstetrics & Gynecology, George Washington University School of Medicine, Washington, DC
Amal Gharamti Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
Mohamad Yasmin Department of Internal Medicine, Case Western Reserve University, Cleveland, OH
Salma Jabak Department of Obstetrics & Gynecology, King's College Hospital, London, United Kingdom
Tania Baban Department of Ophthalmology, University of Balamand, El Koura, Lebanon
Nisreen Sidani Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
Zeina A. Kanafani Department of Internal Medicine, American University of Beirut, Beirut, Lebanon https://orcid.org/0000-0001-8814-1286

DOI:

https://doi.org/10.54034/mic.e1692

Keywords:

staphylococcus aureus, methicillin-resistance, antimicrobial-resistant

Abstract

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated with significant morbidity and mortality. In Lebanon, MRSA rates have recently started to rise. We aimed to determine risk factors for acquiring MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA) infections and identify independent risk factors for in-hospital mortality among patients with S. aureus infection. Methods. We used a case-case-control study design that included patients with infections and compared them to uninfected controls. Two multivariable regression models were constructed to determine variables associated with acquiring MRSA and MSSA infections. We explored independent predictors of mortality in the overall population compared with the MRSA subgroup. Results. 356 patients with S. aureus infections were identified and compared to 208 uninfected controls. A recent history of surgery and underlying diabetes were independent risk factors for acquiring both infections. Having a urinary catheter for more than 6 days and steroid therapy were unique risk factors for MRSA infection (aOR 28.1, 95% CI 3.5-223.6 and 3.7, 95% CI 1.6-8.7, respectively). Risk factors exclusively associated with MRSA infection included ICU admission, acute renal failure, and malignancy. Conclusions. Risk factors associated with MRSA infection are distinct from those associated with MSSA infection. This can be used to risk stratify patients and will aid in choosing empirical antibiotic therapy.

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References

Thampi N, Showler, A., Burry, L., Bai, A. D., Steinberg, M., Ricciuto, D. R., ... & Morris, A. M. (2015). M. Multicenter study of health care cost of patients admitted to hospital with Staphylococcus aureus bacteremia: impact of length of stay and intensity of car. American journal of infection control, 43(7), 739-744. 2015.

Garoy EY GY, Achila OO, Tekeste DG, Kesete R, Ghirmay R, Kiflay R, Tesfu T. Prevalence and Antimicrobial Sensitivity Pattern among Patients-A Multicenter Study in Asmara, Eritrea. Can J Infect Dis Med Microbiol. 2019.

Chen B, Li, S., Lin, S., Huang, M., & Dong, H. The association between antibiotics and community-associated Staphylococcus aureus colonization in the United States population: Analysis of the National Health and Nutrition Examination Survey (NHANES). . Medicine, 101(45). 2022.

Siddiqui AH KJ. Methicillin Resistant Staphylococcus Aureus. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2022.

Hu X HK, Liu Y, Zeng L, Hu N, Chen X, Zhang W. Risk factors for methicillin-resistant Staphylococcus aureus colonization and infection in patients with human immunodeficiency virus infection: A systematic review and meta-analysis. J Int Med Res. 2022.

Jackson KA, Bohm MK, Brooks JT, Asher A, Nadle J, Bamberg WM, et al. Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Persons Who Inject Drugs - Six Sites, 2005-2016. MMWR Morb Mortal Wkly Rep. 2018;67(22):625-8.

Yarovoy JY MA, Knepper BC, Young HL. Epidemiology of Community-Onset Staphylococcus aureus Bacteremia. West J Emerg Med. 2019.

Moghnieh RA, Kanafani ZA, Tabaja HZ, Sharara SL, Awad LS, Kanj SS. Epidemiology of common resistant bacterial pathogens in the countries of the Arab League. Lancet Infect Dis. 2018;18(12):e379-e94.

Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, et al. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J Infect Dis. 2016;46:64-70.

Cadena J, Thinwa J, Walter EA, Frei CR. Risk factors for the development of active methicillin-resistant Staphylococcus aureus (MRSA) infection in patients colonized with MRSA at hospital admission. Am J Infect Control. 2016;44(12):1617-21.

Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol. 2019;56(8):907-21.

Ayau P, Bardossy AC, Sanchez G, Ortiz R, Moreno D, Hartman P, et al. Risk Factors for 30-Day Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections. Int J Infect Dis. 2017;61:3-6.

Walker JN, Flores-Mireles AL, Pinkner CL, Schreiber HLt, Joens MS, Park AM, et al. Catheterization alters bladder ecology to potentiate Staphylococcus aureus infection of the urinary tract. Proc Natl Acad Sci U S A. 2017;114(41): E8721-E30.

Ramarathnam V, De Marco B, Ortegon A, Kemp D, Luby J, Sreeramoju P. Risk factors for development of methicillin-resistant Staphylococcus aureus infection among colonized patients. Am J Infect Control. 2013;41(7):625-8.

De Rosa FG, Corcione S, Motta I, Petrolo A, Filippini C, Pagani N, et al. Risk factors for mortality in patients with Staphylococcus aureus bloodstream infection. J Chemother. 2016;28(3):187-90.

Yilmaz M, Elaldi N, Balkan, II, Arslan F, Batirel AA, Bakici MZ, et al. Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study. Ann Clin Microbiol Antimicrob. 2016;15:7.

Jorgensen SCJ, Lagnf AM, Bhatia S, Rybak MJ. A new simplified predictive model for mortality in methicillin-resistant Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis. 2019;38(5):843-50.

Mahajan SN, Shah JN, Hachem R, Tverdek F, Adachi JA, Mulanovich V, et al. Characteristics and outcomes of methicillin-resistant staphylococcus aureus bloodstream infections in patients with cancer treated with vancomycin: 9-year experience at a comprehensive cancer center. Oncologist. 2012;17(10):1329-36.

Naves KSC, Trindade, N.V.D. and Gontijo Filho, P.P. Methicillin-resistant Staphylococcus aureus bloodstream infection: risk factors and clinical outcome in non-intensive-care units. . Revista da Sociedade Brasileira de Medicina Tropical, 45, pp189-193. 2012.

Kale-Pradhan PB MN, Wilhelm SM, Johnson LB. Meta-Analysis: Vancomycin Treatment Failures for MRSA Bacteremia Based on MIC Determined by E-test. J Pharm Technol. 2016.