Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland

BMC Geriatrics, Feb 2017

Background The proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia. Methods This is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years. Results The prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14–0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2.8, 95%CI 1.06–7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098–4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years. Conclusions MRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections.

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Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland

Pomorska-Wesołowska et al. BMC Geriatrics Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland Monika Pomorska-Wesołowska 2 Anna Różańska 0 Joanna Natkaniec 0 Barbara Gryglewska 1 Anna Szczypta 4 Mirosława Dzikowska 3 Agnieszka Chmielarczyk 0 Jadwiga Wójkowska-Mach 0 0 Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , 18 Czysta Street, 31-121 Krakow , Poland 1 Department of Internal Medicine and Gerontology, Jagiellonian University Medical College , Krakow , Poland 2 Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska, KORLAB NZOZ , Ruda Slaska , Poland 3 Department of Clinical Nursing Jagiellonian University Medical College , Krakow , Poland 4 Faculty of Health and Medical Sciences, Andrzej Frycz-Modrzewski Krakow University , Krakow , Poland Background: The proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia. Methods: This is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years. Results: The prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14-0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2. 8, 95%CI 1.06-7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098-4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years. Conclusions: MRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections. MRSA; Longevity; Trimethoprim/sulfamethoxazole; Antibiotic resistance; Infection - Background The proportion of the population aged ≥65 years is rising steadily. It is estimated that by 2025 the number of such people will increase by more than two-fold [1]. The older population (>65 years) is anticipated to exceed 1 billion persons by 2030 [2]. The average age of European individuals is already the highest in the world. In 2000, people aged ≥65 years represented 14% of the population, which is expected to increase to 25% of the population by 2050 [3]. Thus, challenges associated with infections in older patients and their impact on medical and socioeconomic systems in developing countries require specific assessment [2, 4]. An increased burden of infection in the older is linked to agerelated dysfunction of the immune system, malnutrition and anatomic and physiological modifications. Antimicrobial therapy is often less effective in older patients owing to the rare initiation of empiric therapy and late diagnosis © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. because older individuals often exhibit fewer signs and symptoms of infections. Staphylococcus aureus (SA) is a microorganism that comprises normal human flora with the capacity to cause serious infections. SA primarily colonizes warm and moist regions of mucous membranes, especially the nasal v (...truncated)


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Monika Pomorska-Wesołowska, Anna Różańska, Joanna Natkaniec, Barbara Gryglewska, Anna Szczypta, Mirosława Dzikowska, Agnieszka Chmielarczyk, Jadwiga Wójkowska-Mach. Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland, BMC Geriatrics, 2017, pp. 51, 17, DOI: 10.1186/s12877-017-0442-3