A GIS Approach to Staphylococcus Associated Mortality in Texas in 2005

1. A GIS Approach toStaphylococcus 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

2. 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.

3. 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

4. Texas Staphylococcal Death Cases in 2005

5. Texas Staphylococcal Death Cases in 2005

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

7. Race/Ethnicity † Reference group

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

9. Number of deaths per year reporting staphylococcus as a contributing COD

10. Number of deaths per year reporting staphylococcus as the underlying COD

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

12. Demographic variables associated with deaths due to MRSA compared with deaths due to MSSA

13. Demographic variables associated with deaths due to MRSA compared with deaths due to MSSA

14. Association of site of staphylococcal infection with MRSA compared with MSSA

15. 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.

16. Antibiotic Classification

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

18. 2005 Texas Population and Staph Death Count

19. 2005 Texas Population and Staph Death Rate (per 100,000)

20. 2005 Texas Population and Staphylococcal Death (Per 100,000)

21. Staphylococcal Death Count and Rate (per 100,000)

22. Rural Urban Continuum Code by Staph Death Count

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

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

25. 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