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A GIS Approach toStaphylococcus Associated Mortality
in Texas in 2005By
Samuel F. Barker, MTSchool of Rural Public Health
Texas A&M Health Science Center
Refer all questions to: [email protected]
Updates and Assumptions
• Oxacillin, Nafcillin, and Methicillin were treated equally to establish methicillin resistance.
• By definition, MRSA is genetically resistant to:• Betalactams• Cephalosporins• Carbapenems
• Intermediate resistance was treated as resistant based on clinical treatment protocols.
Texas Death Cohort 2005
• 155,924 deaths on record
• 439 records listed Staphylococcus sp. as a contributing cause
• 223 records listed Staphylococcus sp. as the underlying cause
• 210 records requested
• 114 complete records received
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# Staph Death Cases
Texas Counties
Texas Staphylococcal Death Cases in 2005
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Houston
Dallas
Austin
El Paso
San Antonio
Fort Worth
Waco
Abilene
LubbockPlano
Corpus Christi
Beaumont
Amarillo
Laredo
# Staph Death Cases
Texas Counties
Texas Staphylococcal Death Cases in 2005
Response rates to requests for laboratory records by facilities in which staphylococcal
deaths occurred in Texas, 2004-2005
Response
20041 20052
Adequate information 77 (68.2) 114 (51.2)No culture reports 12 (10.6) 40 (17.9)No response 24 (21.2) 69 (30.9)Total 113 (100) 223 (100)
2 Medical records requested on 210 deaths
Number ( %)
1 Medical records requested on sample of 197 total deaths
2004
Race MRSA# (%)
MSSA# (%)
White † 39 (67.2) 19 (37.8)
Black 5 (71.4) 2 (28.6)
Other 8 (66.7) 4 (33.3)
Race/Ethnicity
† Reference group
Culture sources of staphylococcal infectionsresulting in death in Texas, 2004-2005
Culture Source 20041 20052
Blood 53 (68.8) 51 (44.7)Sputum 11 (14.3) 36 (31.6)Bronchial Wash 3 (3.9) 7 (6.1)Respiratory 3 (3.9) 5 (4.4)Catheter Tip 2 (2.6) 0 (0.0)Skin 1 (1.3) 0 (0.0)Spinal fluid 2 (2.6) 0 (0.0)Wound 1 (1.3) 10 (8.8) Urine 0 (0.0) 4 (3.5)Arterial Line 0 (0.0) 1 (0.9)Not Listed 1 (1.3) 0 (0.0)
Total 77 (100) 114 (100)
2 Medical records requested on 210 deaths
Number ( %)
1 Medical records requested on sample from 197 deaths
Contributing Cause of Death 2000 2001 2002 2003 2004 2005
Staphylococcal septicemia 220 261 250 215 236 247 (ICD10: A41.0, A41.1, A41.2, P36.2, P36.3)
Staphylococcus aureus septicemia 83 (38%) 121 (46%) 143 (57%) 109 (51%) 121 (51%) 132 (53%)
(ICD 10: A41.0,P36.2)
Staphylococcal pneumonia 88 91 107 120 100 103 (ICD10: J15.2, P23.2)
Staphylococcal infection, unspecified 31 56 47 80 110 87 (ICD10: A49.0)
Staphylococcal meningitis 4 2 2 1 2 1 (ICD10: G00.3)
Staphylococcal arthritis/polyarthritis 0 1 0 0 0 1 (ICD10: M00.0)
Total 343 411 406 416 448 439
Number of deaths per year reporting staphylococcus as a contributing COD
Underlying Cause of Death 2000 2001 2002 2003 2004 2005
Staphylococcal septicemia 94 80 94 88 107 105 (ICD10: A41.0, A41.1, A41.2, P36.2, P36.3) Staphylococcus aureus septicemia 37 (39%) 40 (50%) 46 (49%) 45 (51%) 49 (46%) 62 (59%)
(ICD 10: A41.0,P36.2)
Staphylococcal pneumonia 54 66 72 72 67 97 (ICD10: J15.2, P23.2)
Staphylococcal infection, unspecified 7 14 11 14 17 17 (ICD10: A49.0)
Staphylococcal meningitis 0 1 2 0 5 3 (ICD10: G00.3)
Staphylococcal arthritis/polyarthritis 1 0 0 0 1 1 (ICD10: M00.0)
Total 156 161 179 174 197 223
Number of deaths per year reporting staphylococcus as the underlying COD
Staphylococcal species responsible for infections resulting in death in Texas, 2004-2005
Species
20041 20052
Coagulase Positive, S. aureus 68 (88.3) 108 (94.7)Coagulase Negative 9 (11.7) 6 (5.3)
S. epidermidus 5 (6.5) 3 (2.6)S. haemolyticus 1 (1.3) 1 (0.9)Unspecified 3 (3.9) 2 (1.8)
Total 77 (100.0) 114 (100)1 Medical records requested on sample of 197 total deaths 2 Medical records requested on 210 deaths
Number (%)
Demographic variables associated with deaths due to MRSA compared with deaths due to MSSA
2004 2005
Sex MRSA# (%)
MSSA# (%)
MRSA# (%)
MSSA# (%)
Male † 33 (64.7) 18 (35.3) 50 (80.6) 12 (19.4)
Female 19 (73.9) 7 33 (73.3) 12 (26.7)
† Reference group
Demographic variables associated with deaths due to MRSA compared with deaths due to MSSA
2004 2005
Age MRSA# (%)
MSSA# (%)
MRSA# (%)
MSSA# (%)
Mean Age 61 59 69 75
≥ 30 † 5 (55.6) 4 (44.4) 6 (85.7) 1 (14.3)
31 - 60 16 (69.6) 7 (30.4) 18 (85.7) 3 (14.3)
> 60 31 (68.9) 14 (31.1) 59 (74.7) 20 (25.3)
† Reference Group
Cause of Death (ICD-10 Codes) MRSA MSSA OR (95% CI) MRSA MSSA OR (95% CI)Staphylococal septicemia† 22 (55.0) 18 (45.0) 1.0† 39 (47.0) 14 (58.3) 1.0†
(A41.0, A41.1, A41.2, P36.2, P36.3)
Staphylococal pneumonia 26 (92.9) 2 (7.1) 10.6 (2.1, 101.4) 41 (49.4) 9 (37.5) 1.6 (0.6, 4.8) (J15.2, P23.2)
Staphylococal infection, unspecified 2 (40.0) 3 (60.0) 0.6 (0.4, 5.38) 3 (3.6) 1 (4.2) 1.1 (0.1, 60.5) (A49.0)
Staphylococal meningitis 2 (50.0) 2 (50.0) 0.8 (0.1, 12.4) 0.0 0.0 0.0 (G00.3)
Total 52 25 83 24† Reference Group
2004 2005
Association of site of staphylococcal infection with MRSA compared with MSSA
Percent antibiotic resistance of staphylococcal species as reported on susceptibility tests for persons dying of
staphylococcal infections in Texas, 2004-2005 Antibiotic Resistant/Total (%)
2004 2005 Penicillin
61/65 (93.8) 106/112 (94.6) Oxacillin 59/76 (77.6) 87/111 (78.4) Ampicillin 44/50 (88.0) 106/112 (94.6) Amoxicillin 25/32 (78.1) 106/112 (94.6) Clindamycin 26/62 (41.9) 53/98 (54.1) Cefazolin 45/57 (78.9) 87/110 (79.1) Ceftriaxone 21/27 (77.8) 88/110 (80.0) Cefotaxime 8/11 (72.7) 87/108 (80.6) Cefepime 2/2 (100.0) 87/109 (79.8) Cephalothin 3/5 (60.0) 86/108 (79.6) Erythromycin 54/66 (81.8) 81/99 (81.8) Azithromycin 7/10 (70.0) 11/14 (78.6) Clarithromycin 3/4 (75.0) 5/5 (100.0) Gentamicin 7/52 (13.5) 5/89 (5.6) Trim/Sulfa 6/71 (8.5) 3/101 (3.0) Tetracycline 8/57 (14.0) 6/87 (6.9) Vancomycin 1*/69 (1.4) 2*/106 (1.9) Levofloxacin 34/51 (66.7) 58/79 (73.4) Ciprofloxacin 20/28 (71.4) 35/49 (71.4) Rifampin 3/40 (7.5) 2/76 (2.6) Imipenem
Lin
10/14 (71.4) 85/102 (83.3) Linezolid 0/7 (0.0) 0/37 (0.0) Synercid 0/0 (0.0) 0/16 (0.0)
*Data are based on hospital laboratory reports. No vancomycin resistant staphylococcus have been confirmed in Texas.
Antibiotic Classification
PenicillinsCephalosporins/Cephamycins Macrolides Aminoglycosides Quinolones Sulfonamides Tetracyclines Glycopeptides
Amoxicillin Cefaclor Azithromycin Amikacin Ciprofloxacin Doxycycline VancomycinAmoxicillin/Clavulinate Cefazolin Erythromycin Gentamicin Gatifloxacin TetracyclineAmpicillin Cefepime Clarithromycin LevofloxacinAmpicillin/Sulbactam Cefotaxime MoxifloxacinMethicillin Ceftriaxone NorfloxacinNafcillin Cefuroxime OfloxacinOxacillin Cephalothin SparfloxacinPenicillin GPiperacillinPiperacillin/TazobactamTicarcillin/Clavulinate
Rifampins Carbapenems Lincosamides Streptogramins Oxazolidinone Amphenicols NitrofuransRifampin Imipenem Clindamycin Synercid Linezolid Chloramphenicol Nitrofurantoin
Meropenem
Trimethoprim/Sulfamethoxazole
Percent antibiotic class resistance of staphylococcal species as reported on susceptibility tests for persons dying of
staphylococcal infections in Texas, 2004-2005
Antibiotic Class Resistant/Total (%)
(%)
Resistant/Total (%) 2004 2005 Cephalosporins & CCephamy
50/61 (82.0) 88/110 (80.0) Cephamycins Macrolides 54/67 (80.6) 82/99 (82.8) Aminoglycosides 7/52 (13.5) 6/89 (6.7) Sulfonamides 6/71 (8.5) 3/101 (3.0) Tetracyclines 8/57 (14.0) 6/87 (6.9) Glycopeptides 1/69 (1.4) 2/106 (1.9) Quinolones 39/58 (67.2) 67/89 (75.3) Rifampins 3/40 (7.5) 2/76 (2.6) Carbapenems 10/14 (71.4) 85/102 (83.3) Lincosamides 0/7 (0.0) 53/98 (54.1)
Texas Pop. 200554 - 5000
5001 - 12500
12501 - 25000
25001 - 50000
50001 - 3735075
Staph Death Count1
2
3
4 - 5
6 - 36
2005 Texas Population and Staph Death
Count
Texas Pop. 200554 - 5000
5001 - 12500
12501 - 25000
25001 - 50000
50001 - 3735075
Staph Death Rate0.18 - 1.00
1.01 - 2.00
2.01 - 4.00
4.01 - 10.00
10.01 - 25.00
2005 Texas Population and Staph Death Rate
(per 100,000)
Houston
Dallas
Austin
El Paso
San Antonio
Fort Worth
Abilene
Port Arthur
Corpus Christi
Tyler
Amarillo
Midland
Laredo
San Angelo
Wichita Falls
McAllen
Killeen
Galveston
Brownsville
Texas Pop. 200554 - 5000
5001 - 12500
12501 - 25000
25001 - 50000
50001 - 3735075
Staph Deaths
Death Count
Death Rate
2005 Texas Population and Staphylococcal Death
(Per 100,000)
Staph Death Rate0.18 - 1.00
1.01 - 2.00
2.01 - 4.00
4.01 - 10.00
10.01 - 25.00
No Deaths
Staph Death Count1
2
3
4 - 5
6 - 36
Staphylococcal Death Count and Rate (per
100,000)
Rural Urban Cont. Code
Metro 250,000+
Metro <250.000
Urban 20,000+
Urban 2,500-20,000
Rural <2,500
Staph Death Count
1
2
3
4 - 5
6 - 36
Rural Urban Continuum Code by Staph Death Count
Rural Urban Cont. Code
Metro 250,000+
Metro <250.000
Urban 20,000+
Urban 2,500-20,000
Rural <2,500
Staph Death Rate
0.18 - 1.00
1.01 - 2.00
2.01 - 4.00
4.01 - 9.00
9.01 - 25.00
RUC Code and Staph Death Rate (per 100,000)
Houston
Dallas
Austin
El Paso
San Antonio
Fort Worth
Waco
Abilene
Port Arthur
Corpus Christi
Tyler
Amarillo
Midland
Laredo
San Angelo
Wichita Falls
McAllen
Killeen
Galveston
Brownsville
Rural Urban Cont. CodeMetro 250,000+
Metro <250.000
Urban 20,000+
Urban 2,500-20,000
Rural <2,500
Staph Deaths
Death Count
Death Rate
Staphylococcal Death by Rural-Urban Continuum Code
(Per 100,000)