Abstract：
BACKGROUND: Cases of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection have been increasing. Patients with MRSA bloodstream infection have a poor prognosis and high mortality rate. Identification of potential risk factors associated with MRSA bloodstream infection-related mortality may help improve patient outcomes.
METHODS: Embase, PubMed, and the Cochrane Library databases were searched to identify articles describing predictors of mortality in patients with MRSA bloodstream infections. Two investigators independently assessed articles for inclusion and data extraction.
RESULTS: Twenty observational studies were included in the analysis. Factors associated with higher mortality were development of severe sepsis or septic shock [odds ratio (OR): 4.56, 95% CI: 3.37-6.18], congestive heart failure (OR: 1.78, 95% CI: 1.27-2.50), liver cirrhosis (OR: 1.90, 95% CI: 1.27-2.65), malignancy (OR: 1.62, 95% CI: 1.33-1.98), infective endocarditis (OR: 2.05, 95% CI: 1.35-3.11), nosocomial infection (OR: 2.80, 95% CI: 1.41-5.55), intensive care unit admission (OR: 3.08, 95% CI: 1.49-6.36) and inappropriate empirical antimicrobial treatment (OR: 2.25, 95% CI: 1.16-4.36); removal of the eradicable foci was a protective factor (OR: 0.51, 95% CI: 0.40-0.63) The average APACHE II score at the time of diagnosis of MRSA bloodstream infection was considerably higher in patients who did not survive than in those who survived [weighted mean difference (WMD): 5.81, 95% CI: 3.03-8.59].
CONCLUSIONS: Patient condition, appropriate timing of antimicrobial treatment, surgical intervention and disease severity according to the APACHE II score are the most important risk factors for death in patients with MRSA bloodstream infections.
METHODS: Embase, PubMed, and the Cochrane Library databases were searched to identify articles describing predictors of mortality in patients with MRSA bloodstream infections. Two investigators independently assessed articles for inclusion and data extraction.
RESULTS: Twenty observational studies were included in the analysis. Factors associated with higher mortality were development of severe sepsis or septic shock [odds ratio (OR): 4.56, 95% CI: 3.37-6.18], congestive heart failure (OR: 1.78, 95% CI: 1.27-2.50), liver cirrhosis (OR: 1.90, 95% CI: 1.27-2.65), malignancy (OR: 1.62, 95% CI: 1.33-1.98), infective endocarditis (OR: 2.05, 95% CI: 1.35-3.11), nosocomial infection (OR: 2.80, 95% CI: 1.41-5.55), intensive care unit admission (OR: 3.08, 95% CI: 1.49-6.36) and inappropriate empirical antimicrobial treatment (OR: 2.25, 95% CI: 1.16-4.36); removal of the eradicable foci was a protective factor (OR: 0.51, 95% CI: 0.40-0.63) The average APACHE II score at the time of diagnosis of MRSA bloodstream infection was considerably higher in patients who did not survive than in those who survived [weighted mean difference (WMD): 5.81, 95% CI: 3.03-8.59].
CONCLUSIONS: Patient condition, appropriate timing of antimicrobial treatment, surgical intervention and disease severity according to the APACHE II score are the most important risk factors for death in patients with MRSA bloodstream infections.
摘要：
背景：耐甲氧西林金黄色葡萄球菌（MRSA）血流感染的病例一直在增加。MRSA血流感染患者预后差,病死率高。识别与MRSA血流感染相关死亡率相关的潜在危险因素可能有助于改善患者预后。
方法：Embase，PubMed,我们搜索了CochraneLibrary数据库,以确定描述MRSA血流感染患者死亡率预测因素的文章.两名研究人员独立评估文章的纳入和数据提取。
结果：20项观察性研究纳入分析。与较高死亡率相关的因素是严重脓毒症或脓毒性休克的发展[比值比（OR）：4.56，95％CI：3.37-6.18]，充血性心力衰竭（OR：1.78，95%CI：1.27-2.50），肝硬化（OR：1.90，95%CI：1.27-2.65），恶性肿瘤（OR：1.62，95%CI：1.33-1.98），感染性心内膜炎（OR：2.05，95%CI：1.35-3.11），医院感染（OR：2.80，95%CI：1.41-5.55），重症监护病房（OR：3.08，95％CI：1.49-6.36）和不适当的经验性抗菌治疗（OR：2.25，95％CI：1.16-4.36）；清除可根除病灶是保护因素（OR：0.51，95％CI：0.40-0.63）
结论：患者情况，抗菌治疗的适当时机，根据APACHEⅡ评分,手术干预和疾病严重程度是MRSA血流感染患者死亡的最重要危险因素.
方法：Embase，PubMed,我们搜索了CochraneLibrary数据库,以确定描述MRSA血流感染患者死亡率预测因素的文章.两名研究人员独立评估文章的纳入和数据提取。
结果：20项观察性研究纳入分析。与较高死亡率相关的因素是严重脓毒症或脓毒性休克的发展[比值比（OR）：4.56，95％CI：3.37-6.18]，充血性心力衰竭（OR：1.78，95%CI：1.27-2.50），肝硬化（OR：1.90，95%CI：1.27-2.65），恶性肿瘤（OR：1.62，95%CI：1.33-1.98），感染性心内膜炎（OR：2.05，95%CI：1.35-3.11），医院感染（OR：2.80，95%CI：1.41-5.55），重症监护病房（OR：3.08，95％CI：1.49-6.36）和不适当的经验性抗菌治疗（OR：2.25，95％CI：1.16-4.36）；清除可根除病灶是保护因素（OR：0.51，95％CI：0.40-0.63）
结论：患者情况，抗菌治疗的适当时机，根据APACHEⅡ评分,手术干预和疾病严重程度是MRSA血流感染患者死亡的最重要危险因素.
