MRSA in the critically ill

¹Intensive Care Unit, Chelsea and Westminster Hospital, Fulham Rd, SW10 9NH, UK.

|June 29, 2001

Abstract:

MRSA colonization and infection rates were prospectively examined over an 18 month period in a general Intensive Care Unit. Of 642 admissions, 305 were in ICU for longer than 48 h and were hence included and a further three patients were already colonized at admission but stayed less than 48 h. Ninety-seven patients were colonized with MRSA including 19 who were already colonized at admission. There were 56 episodes of clinical infection in 43 patients. The mortality rates in the colonized and infected groups, were 14.8% and 16.2% respectively, while the rate in those not colonized was 23%. These figures were not statistically different. Those colonized or infected with MRSA had significantly longer ICU stays than those not colonized. Sputum colonization and infection was a major site for MRSA. There was diagnostic certainty of MRSA infection in 40% of cases emphasizing the difficulty in diagnosis of infection due to MRSA in the critically ill. Both colonization and infection with MRSA are associated with longer ICU stay but do not appear to influence mortality.

Insights

Methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection prolong Intensive Care Unit (ICU) stays. However, MRSA did not significantly impact mortality rates in critically ill patients.

Area of Science:

Infectious Diseases
Critical Care Medicine
Microbiology

Background:

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in healthcare settings.
Understanding MRSA colonization and infection dynamics is crucial for patient outcomes in Intensive Care Units (ICUs).

Purpose of the Study:

To prospectively examine MRSA colonization and infection rates.
To assess the impact of MRSA on mortality and ICU length of stay.
To identify key sites of MRSA colonization and infection.

Main Methods:

Prospective study over 18 months in a general ICU.
Inclusion criteria: ICU stay > 48 hours.
Data collection on MRSA colonization, infection, and patient outcomes.

Main Results:

97 out of 305 eligible patients were colonized with MRSA.
56 episodes of MRSA infection occurred in 43 patients.
MRSA colonization/infection was associated with significantly longer ICU stays but not increased mortality.
Sputum was a major site for MRSA colonization and infection.
Diagnostic certainty of MRSA infection was only 40%.

Conclusions:

MRSA colonization and infection are common in ICUs and lead to prolonged ICU stays.
MRSA does not significantly influence mortality in the critically ill.
Challenges exist in diagnosing MRSA infections in critically ill patients.

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