Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit

results from the EPIC II study

Hkan Hanberger, Sten Walther, Marc Leone, Philip S. Barie, Jordi Rello, Jeffrey Lipman, John C. Marshall, Antonio Anzueto, Yasser Sakr, Peter Pickkers, Peter Felleiter, Milo Engoren, Jean Louis Vincent*, EPIC II Investigators

*Corresponding author for this work

Research output: Contribution to journalArticle

113 Citations (Scopus)


Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P < 0.01) and corresponding hospital mortality rates were 36.4% and 27.0% (P < 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P = 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.

Original languageEnglish
Pages (from-to)331-335
Number of pages5
JournalInternational Journal of Antimicrobial Agents
Issue number4
Publication statusPublished - 1 Oct 2011
Externally publishedYes


  • Antimicrobial resistance
  • Critically ill
  • Mortality
  • Sepsis

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