Death certification following MRSA bacteraemia, England, 2004-05

This study examined factors affecting whether or not meticillin resistant Staphylococcus aureus(MRSA) is recorded on the death certificate of individuals who died following a laboratory confirmed MRSA bacteraemia and compared this with another organism, Streptococcus pneumoniae. The study included all patients with a positive MRSA or S. pneumoniae bacteraemia reported to the Health Protection Agency between 1 January 2004 and 31 December 2005 and linked to a death registered up to 31 March 2006. It was an opportunistic analysis of infection surveillance records and death registrations that had been linked for other purposes Certifiers are most likely to record MRSA on the death certificate if they believe that a large number of conditions contributed to the patient's death, and if the patient dies between 2 and 15 days following a positive blood culture. Certifiers do not appear to be deliberately omitting MRSA from death certificates; rather they report the clinical manifestation of infection or disease the patient died from, not the microbiological diagnosis. Certifiers were significantly less likely to mention S. pneumoniae than MRSA.