Analysis of Clinical Subphenotypes in Methicillin-Resistant Staphylococcus aureus Bacteremia: A Post Hoc Analysis of the MRSA-GEIRAS-SEIMC Study - Report - MDSpire
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Analysis of Clinical Subphenotypes in Methicillin-Resistant Staphylococcus aureus Bacteremia: A Post Hoc Analysis of the MRSA-GEIRAS-SEIMC Study
Clinical Subphenotypes in MRSA Bacteremia and Their Impact on 90-Day Mortality
Overview
This post hoc analysis of 419 patients with methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) identified four distinct clinical subphenotypes with significantly different 90-day mortality rates. Subphenotypes characterized by older age, comorbidities, and metastatic foci showed higher mortality risks compared to younger, community-acquired cases.
Background
Staphylococcus aureus bacteremia (SAB) is a major cause of morbidity and mortality worldwide, with methicillin-resistant strains (MRSA) associated with worse outcomes. Traditional classifications of SAB episodes inadequately capture clinical heterogeneity and prognostic factors such as infection source and comorbidities. Identifying clinical subphenotypes may improve risk stratification and guide therapeutic decisions, especially in MRSA infections where treatment options and outcomes vary.
Data Highlights
Subphenotype
Characteristics
90-Day Mortality (%)
Hazard Ratio (95% CI) vs S1
S1
Younger age, community acquisition, unknown or skin/soft tissue infection source
20.0
Reference
S2
Older age, female sex, high comorbidity burden, healthcare-related acquisition
47.4
2.98 (1.59–5.56)
S3
Catheter source, nosocomial acquisition
26.2
Not specified
S4
Heart valve prostheses, metastatic foci
35.1
1.99 (1.16–3.42)
Key Findings
Four distinct clinical subphenotypes of MRSAB were identified using principal component and latent class analyses.
Subphenotype S2 (older, comorbid, healthcare-related) had the highest 90-day mortality at 47.4% and nearly threefold increased death risk compared to S1.
Subphenotype S4, characterized by heart valve prostheses and metastatic foci, also showed significantly increased mortality risk.
Subphenotypes differed by age, sex, infection source, acquisition setting, and presence of metastatic complications.
Traditional SAB classifications may overlook important prognostic heterogeneity captured by these subphenotypes.
Clinical Implications
Recognizing distinct clinical subphenotypes in MRSAB can enhance prognostic accuracy and identify patients at higher risk of mortality who may benefit from intensified monitoring or alternative therapeutic strategies. Incorporation of subphenotype classification into clinical practice could guide personalized treatment decisions and improve outcomes. Further prospective validation is needed to implement these findings.
Conclusion
This study demonstrates that clinical subphenotyping of MRSAB patients reveals meaningful prognostic groups with differing mortality risks. These insights may inform future risk stratification and tailored management approaches in MRSA bacteremia.
References
MRSA-GEIRAS-SEIMC Study Group 2023 -- Evaluation of Clinical Subphenotypes in Methicillin-Resistant Staphylococcus aureus Bacteremia
by Sofía De La Villa, Nuria Fernández-Hidalgo, Francesc Escrihuela-Vidal, Rosa Escudero-Sánchez, Itxasne Cabezón, Lucía Boix-Palop, Beatriz Díaz-Pollán, Ane Josune Goikoetxea, María José García-País, Lucía Ramos-Merino, María Teresa Pérez-Rodríguez, Ángela Crespo, Lara del Río, José María Bellón-Cano, Patricia Muñoz, on behalf of, MRSA-GEIRAS-SEIMC study group, Damaris Berbel, Luis Buzón-Martín, David Campany, Alex García-Tellado, Inmaculada Grau, José Manuel Guerra-Laso, Joan Roig-Sanchis, Celia Sánchez-Martínez, Oscar Sanz, Fiorana Silvante, Belén Viñado, Luciana Urbina, Ana V Halperin, Mariona Xercavins
