Methicillin resistant staphylococcus aureus natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
- People in good health with a healthy immune system recover well from MRSA infections.
- Immunodeficiency patients suffer from severe forms of the disease, resulting in complications.
Complications
Complications of MRSA infection depends on the site of involvement. Some of the complications include:
- Septicemia
- Endocarditis
- Osteomyelitis
- Septic arthritis
- Pneumonia
- Necrotizing fasciitis
- Toxic shock syndrome
- CA-MRSA is associated with thrombosis
- Death
Prognosis
MRSA in healthcare settings commonly causes serious and potentially life threatening infections, such as bloodstream infections, surgical site infections, or pneumonia.
It has been difficult to quantify the degree of morbidity and mortality attributable to MRSA. Patients with S. aureus infection had, on average, 3 times the length of hospital stay (14.3 vs 4.5 days), 3 times the total charges ($48,824 vs $14,141), and 5 times the risk of in-hospital death (11.2% vs 2.3%) than inpatients without this infection. Cosgrove et al, in a meta-analysis of 31 studies, conclude that bacteremia as a result of MRSA is associated with an increased mortality compared with MSSA bacteraemia with an odds ratio of 1.93 (95% CI, 1.54±2.42; In addition, Wyllie et al. report a death rate of 34% within 30 days among patients infected with MRSA, while among MSSA patients the death rate was similar at 27%.
The major issue is that there are a number of factors that can lead to someone's death, and it is believed that patients with MRSA bacteraemia are sicker and will consequently have a higher mortality because of their underlying illness. However, several studies including one by Blot and colleagues that have adjusted for underlying disease still found MRSA bacteraemia to have a higher attributable mortality than MSSA bacteraemia.