I. Cheong et al., METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS BACTEREMIA AT A TERTIARY TEACHING HOSPITAL, British journal of clinical practice, 50(5), 1996, pp. 237-239
Between July and December 1994, 25 patients with MRSA bacteraemia were
treated at the Hospital Kuala Lumpur, a tertiary hospital in Malaysia
with 3000 beds. The patients included 15 males and 10 females whose m
ean age was 46.7 years (range 13-75), The sources of their MRSA were:
Urology/Nephrology, 11; General ICU, six; Orthopaedic, four; Medicine,
three; Surgery, one, Their underlying diseases were: end-stage and ch
ronic renal failure, 11, burns, three; acute necrotising pancreatitis,
two; haematological malignancies, two; and one each of fracture of th
e neck of the femur, pustular psoriasis, alcoholic cirrhosis, liver ab
scess, peptic ulcer (antrectomy), choledochol cyst, and abdominal aneu
rysm with gangrene of the legs. Six patients were also diabetic, A tot
al of 19 infections were considered nosocomial. The duration of hospit
al stay ranged from one to 60 days, mean 16 days. On the day of blood
culture, 20 patients (80%) were febrile and 15 (60%) had leucocytosis.
A total of 14 patients were considered to have received prolonged bro
ad-spectrum antibiotics before the bacteraemia; of these, 11 had had e
ither a third-generation cephalosporin and/or a quinolone. The primary
foci of infection were: vascular access dialysis catheters, six; infe
cted AV fistulae, three; non-surgical wounds, five; orthopaedic pin, o
ne; multiple venous lines and catheters, nine; unknown, one, The sensi
tivities to anti-MRSA antibiotics were: vancomycin, 100%; fusidic acid
, 96%; rifampicin, 96%; ciprofloxacin and perfloxacin 28% each. In all
, 13 patients (52%) eventually died; nine of these deaths were directl
y attributed to MRSA bacteraemia, The microbiological eradication rate
was 88%, Mortality was significantly associated with duration of hosp
ital stay and failure to remove the infected catheters/peripheral line
s after the development of MRSA bacteraemia.