Study finds racial disparities in invasive MRSA incidence remain
A study today in Clinical Infectious Diseases shows that while rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) have decreased in the United States, racial disparities in MRSA rates have not changed.
In the study, researchers from the Centers for Disease Control and Prevention (CDC) and elsewhere analyzed 2005-2014 surveillance data from nine states collected by the CDC's Emerging Infections Program to determine whether reductions in invasive MRSA incidence affected racial disparities in rates. Previous research has consistently documented higher rates of MRSA infections among blacks compared to whites across age groups, but the reasons for this disparity remain unclear.
Case classification included hospital-onset (HO), healthcare-associated hospital-onset (HACO), or community-associated MRSA. Negative binomial regression models evaluated the adjusted rate ratio (aRR) of MRSA in black patients (versus white patients), controlling for age, sex, and temporal trends.
The analysis found that despite substantial decreases in HO and HACO (but not CA) MRSA incidence from 2005 through 2014, the racial disparities did not decline. When adjusted for age, sex, and year, blacks had higher rates for HO MRSA (aRR: 3.20), HACO MRSA (aRR: 3.84), and CA MRSA (aRR: 2.78) incidence, with no significant change in the aRR over time.
"In summary, blacks continue to have a 2-3 times higher incidence rate of healthcare-associated invasive MRSA despite significant decreases in overall disease rates from 2005-2014," the authors write. "Eliminating racial disparities will require improved understanding of the determinants underlying these disparities, as well as prevention strategies to address those determinants."
Apr 5 Clin Infect Dis study
ESBL Klebsiella found more harmful than ESBL E coli
A study today in Infection Control & Hospital Epidemiology found that bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) lead to more severe clinical symptoms and higher death rates than bloodstream infections caused by ESBL-producing Escherichia coli (ESBL-EC).
A large international group of researchers analyzed data on 687 patients with ESBL-EC bloodstream infections and 222 with ESBL-KP bloodstream infections. ESBL-KP was associated with intensive care unit stay, cardiovascular and neurologic comorbidities, length of hospital stay greater than14 days, and a nonurinary source, while ESBL-EC was not.
The investigators also discovered a 33.7% 30-day mortality rate in the ESBL-KP patients, compared with 17.4% in ESBL-EC patients. They noted that CTX-M was the most common ESBL subtype—occurring in 76% of isolates tested—but it was not tied to differences in clinical outcome or death.
The authors concluded, "All ESBL-producing Enterobacteriaceae should not be considered a homogeneous group."
Apr 5 Infect Control Hosp Epidemiol abstract