A GIS Approach to Staphylococcus Associated Mortality in Texas in 2005 By Samuel F. Barker, MT School of Rural Public Health Texas A&M Health Science Center Refer all questions to: Marilyn.Felkner@dshs.state.tx.us

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

Texas Staphylococcal Death Cases in 2005

Texas Staphylococcal Death Cases in 2005

3/26/2009 Response rates to requests for laboratory records by facilities in which staphylococcal deaths occurred in Texas, 2004-2005 Response 2004 1 2005 2 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) Medical records requested on 210 deaths Number ( %) Medical records requested on sample of 197 total deaths

Race/Ethnicity 2004 Race MRSA # (%) MSSA # (%) White † 39 (67.2) # (%) MSSA # (%) White † 39 (67.2) 19 (37.8) Black 5 (71.4) 2 (28.6) Other 8 (66.7) 4 (33.3) † Reference group

Culture sources of staphylococcal infections resulting in death in Texas, 2004-2005 1 2005 2 Blood 53 (68.8) 51 (44.7) Sputum 11 (14.3) 36 (31.6) Bronchial Wash 3 (3.9) 7 (6.1) Respiratory 5 (4.4) Catheter Tip 2 (2.6) 0 (0.0) Skin 1 (1.3) Spinal fluid Wound 10 (8.8) Urine 4 (3.5) Arterial Line 1 (0.9) Not Listed Total 77 (100) 114 (100) Medical records requested on 210 deaths Number ( %) Medical records requested on sample from 197 deaths

Number of deaths per year reporting staphylococcus as a contributing COD

Number of deaths per year reporting staphylococcus as the underlying COD

Staphylococcal species responsible for infections resulting in death in Texas, 2004-2005

Demographic variables associated with deaths due to MRSA compared with deaths due to MSSA 2004 2005 Sex 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 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 3 > 60 31 (68.9) 14 (31.1) (74.7) 20 (25.3) † Reference Group

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 *Data are based on hospital laboratory reports. No vancomycin resistant staphylococcus have been confirmed in Texas.

Antibiotic Classification

Percent antibiotic class resistance of staphylococcal species as reported on susceptibility tests for persons dying of staphylococcal infections in Texas, 2004-2005

2005 Texas Population and Staph Death Count

2005 Texas Population and Staph Death Rate (per 100,000)

2005 Texas Population and Staphylococcal Death (Per 100,000)

Staphylococcal Death Count and Rate (per 100,000)

Rural Urban Continuum Code by Staph Death Count

RUC Code and Staph Death Rate (per 100,000)

Staphylococcal Death by Rural-Urban Continuum Code (Per 100,000)

Special Thanks to J. Charles Huber Jr, PhD Asst. Professor of Biostatistics Dept. of Epidemiology and Biostatistics Texas A&M Health Science Center School of Public Health