1. A GIS Approach to Staphylococcus Associated Mortality in Texas in 2005By
Samuel F. Barker, MT
School of Rural Public Health
Texas A&M Health Science Center
Refer all questions to:

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. 3/26/2009
Response rates to requests for laboratory records by facilities in which staphylococcal deaths occurred in Texas,
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

7. Race/Ethnicity 2004 Race MRSA # (%) MSSA # (%) White † 39 (67.2)
# (%)
MSSA
# (%)
White †
(67.2)
(37.8)
Black
(71.4)
(28.6)
Other
(66.7)
(33.3)
† Reference group

8. Culture sources of staphylococcal infections resulting in death in Texas, 2004-20051
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

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
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

13. 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) 16
(69.6) 7
(30.4) 18 3
> 60 31
(68.9) 14
(31.1)
(74.7) 20
(25.3)
† Reference Group

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,
*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,

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