Death certification following MRSA bacteraemia, England, 2004-05

Area of Science:

• Medical Microbiology
• Public Health Surveillance
• Epidemiology

Background:

• Meticillin-resistant Staphylococcus aureus (MRSA) is a significant healthcare-associated pathogen.
• Accurate recording of causative organisms on death certificates is crucial for public health surveillance.
• Previous studies have highlighted challenges in accurately attributing mortality to specific infections.

Purpose of the Study:

• To investigate factors influencing the recording of MRSA on death certificates following bacteraemia.
• To compare MRSA recording patterns with those of Streptococcus pneumoniae.
• To understand the relationship between clinical diagnosis and microbiological findings in mortality data.

Main Methods:

• Analysis of laboratory-confirmed MRSA and S. pneumoniae bacteraemia cases reported to the Health Protection Agency (2004-2005).
• Linking infection surveillance data with death registrations up to March 2006.
• Retrospective review of death certificates to identify mentions of MRSA or S. pneumoniae.

Main Results:

• Certifiers were more likely to record MRSA if multiple conditions contributed to death and death occurred 2-15 days post-blood culture.
• MRSA was significantly less likely to be mentioned on death certificates compared to S. pneumoniae.
• Certifiers tended to report clinical manifestations rather than microbiological diagnoses.

Conclusions:

• The recording of MRSA on death certificates is influenced by clinical judgment and the complexity of the patient's condition.
• There is a tendency to report the clinical disease rather than the specific microbiological agent.
• Improved methods for linking clinical and microbiological data may enhance the accuracy of mortality statistics for specific pathogens.