Stratification by Shorr risk scoring scheme | |||||||||
---|---|---|---|---|---|---|---|---|---|
Low risk (0–1) | Medium risk (2–5) | High risk (6–10) | |||||||
MRSA n = 9 (%) | Non-MRSA n = 74 (%) | P value | MRSA n = 86 (%) | Non-MRSA n = 58 (%) | P value | MRSA n = 39 (%) | Non-MRSA n = 2 (%) | P value | |
Variables used in Shorr’s risk scoring scheme | |||||||||
Age [median (IQRa)] | 66 (61,76) | 74.5 (61,84.3) | 0.42 | 84 (72.8, 89.3) | 77 (63.5,85.3) | 0.01 | 82 (76,93) | 85.5 (82,89) | 0.7 |
Recent hospitalization within 90 d | 0 | 0 | 27 (31) | 26 (45) | 0.12 | 35 (90) | 1 (50) | 0.23 | |
Prior antibiotic exposure in last 30 d | 0 | 2 (3) | 1 | 20 (23) | 8 (14) | 0.2 | 22 (56) | 1 (50) | 1 |
SNF | 5 (56) | 3 (4) | 0.0002 | 63 (73) | 18 (31) | <0.0001 | 30 (77) | 2 (100) | 1 |
Admission into ICU | 0 | 0 | 34 (40) | 16 (28) | 0.16 | 29 (74) | 2 (100) | 1 | |
History of CVA | 0 | 1 (1) | 1 | 23 (27) | 8 (14) | 0.1 | 18 (46) | 1 (50) | 1 |
Female with diabetes | 1 (11) | 3 (4) | 0.37 | 15 (17) | 9 (16) | 0.82 | 9 (23) | 0 | 0.07 |
Additional variables identified in this study (not included in Shorr’s risk scoring scheme) | |||||||||
APACHE II [median (IQR)] | 11 (8,18.5) | 9 (7,11) | 0.1 | 15 (11, 19.3) | 12 (8,17) | 0.006 | 18 (13,22) | 21.5 (21,22) | 0.52 |
PSI IV and V | 8 (89) | 31 (42) | 0.01 | 78 (91) | 38 (66) | 0.0004 | 37 (95) | 2 (100) | 1 |
Vasopressor | 0 | 0 | 25 (29) | 6 (10) | 0.0075 | 20 (51) | 2 (100) | 0.49 | |
Mechanical ventilation | 1 (11) | 0 | 0.11 | 27 (31) | 13 (22) | 0.26 | 19 (49) | 1 (50) | 1 |
Prior antibiotic exposure in last 90 d | 1 (11) | 3 (4) | 0.37 | 29 (34) | 19 (33) | 1 | 35 (90) | 1 (50) | 0.23 |
History of MRSA infection | 1 (11) | 1 (1) | 0.2 | 19 (22) | 0 | <0.0001 | 7 (18) | 0 | 1 |
History of pneumonia | 1 (11) | 5 (7) | 0.5 | 33 (38) | 10 (17) | 0.009 | 22 (56) | 1 (50) | 1 |
Presence of other infections at admission | 1 (11) | 1 (1) | 0.2 | 36 (42) | 11 (19) | 0.006 | 18 (46) | 1 (50) | 1 |
Presence of feeding tube | 0 | 0 | 32 (37) | 13 (22) | 0.07 | 34 (87) | 2 (100) | 1 | |
Treatment | |||||||||
Empiric anti-MRSA therapy | 3 (33) | 15 (20) | 0.4 | 58 (67) | 22 (38) | 0.0006 | 27 (69) | 1 (50) | 0.54 |
Vancomycin | 2 (67) | 15 (100) | 0.17 | 53 (62) | 20 (91) | 0.002 | 21 (54) | 1 (100) | 1 |
Other agents | 1 (33) | 0 | 5 (6) | 2 (9) | 0.7 | 6 (15) | 0 | 1 | |
Outcomes | |||||||||
Time to stability [median days (IQR)] | 4 (3,11) | 1 (1,4) | 0.03 | 6 (4,10) | 4 (1,7) | 0.052 | 6.5 (5.3,12.8) | 9.5 (0,19) | # |
Clinical failure | 1 (11) | 0 | 0.11 | 23 (27) | 5 (9) | 0.0092 | 14 (36) | 0 | 0.54 |
Mortality 28-day | 0 | 0 | 18 (21) | 4 (7) | 0.03 | 11 (28) | 0 | 1 | |
LOSb survivors [median days (IQR)] | 9.5 (7,15) | 4.5 (3,7) | 0.0005 | 10 (7,14) | 7 (5,14.3) | 0.1 | 10 (6,17) | 12.5 (5,20) | 0.93 |
Readmission 30-day | 2 (22) | 3 (4) | 0.09 | 10 (12) | 9 (16) | 0.65 | 6 (15) | 0 | 1 |