Prevalence of MRSA Bacteremia and Predictors of In‐Hospital Mortality Among Critically Ill Adults in a Tanzanian Intensive Care Unit: A Retrospective Cross‐Sectional Study

ABSTRACT Background and Aims Methicillin‐resistant Staphylococcus aureus bacteremia is associated with high morbidity and mortality in critically ill patients. Management is challenging due to delays in initiating effective therapy, leading to sepsis and septic shock. We aimed to determine the predictors of in‐hospital mortality among adults with MRSA bacteremia and, secondarily, describe MRSA prevalence, clinical characteristics, and susceptibility patterns. Methods We conducted a retrospective cross‐sectional study in the medical intensive care unit of Kilimanjaro Christian Medical Centre between January 2020 and December 2023. Consecutive patients with positive Staphylococcus aureus blood cultures and complete records were included. Demographic and clinical data were extracted from hospital records. We used Chi‐square tests to compare categorical variables and logistic regression to identify mortality predictors. Results Of 114 bloodstream infections, 26 (22.8%) were caused by Methicillin‐resistant Staphylococcus aureus . Fever was the most common presentation (20/26, 76.9%), and leukocytosis was frequent (19/26, 73.1%). Among the 26 patients with MRSA bacteremia, 15 died in hospital, giving an in‐hospital mortality rate of 57.7%. In multivariable analysis, urinary catheterization (aOR 2.68, 95% CI 1.89–8.05, p = 0.008), central line use (aOR 8.00, 95% CI 1.62–51.35, p = 0.019), and intubation (aOR 6.65, 95% CI 1.54–82.02, p = 0.014) independently predicted mortality. Conclusion Methicillin‐resistant Staphylococcus aureus bacteremia was common in critically ill patients and strongly associated with invasive device use. Despite empiric antibiotic use, mortality remained high, partly reflecting delays in definitive therapy and lack of vancomycin minimum inhibitory concentration data. Strengthening infection prevention, optimizing device management, and tailoring empiric therapy are essential to reduce Methicillin‐resistant Staphylococcus aureus ‐related mortality in critical care.