Changing Epidemiology of Community-Onset Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia

Johnson, Leonard B.; Bhan, Arti; Pawlak, Joan; Manzor, Odette; Saravolatz, Louis D.

doi:10.1086/502227

Cited by 37 publications

(24 citation statements)

References 19 publications

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“…14 Seventy percent of patients had been admitted to hospital at least once within the preceding year, which is comparable to other studies. 8 The proportion of patients that had bacteraemia while on intensive care was lower than in other studies, 15 possibly reflecting differences between teaching and district general hospitals. The elective orthopaedic ward had just one episode in four years, which is similar to other units with similar strict screening and isolation policies.…”

Section: Discussionmentioning

confidence: 74%

“…7 The mean age of 71.7 years in this study is higher than in other studies. [7][8][9][10][11] The median age in the present study was 76 years, with almost three-quarters of patients over the age of 65 years. Almost one-quarter of patients was admitted from nursing homes and 42.3% of the community-onset cases came from nursing homes, which is comparable to other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Almost one-quarter of patients was admitted from nursing homes and 42.3% of the community-onset cases came from nursing homes, which is comparable to other studies. 7,8,11 Nursing home residence is a significant risk factor as MRSA carriage rates of 8-19% 12,13 have been described among residents compared with less than 1% in the general population over 65 years of age. 14 Seventy percent of patients had been admitted to hospital at least once within the preceding year, which is comparable to other studies.…”

Section: Discussionmentioning

confidence: 99%

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Community-onset healthcare-associated MRSA bacteraemia in a district general hospital

Karas

Enoch

Emery

2006

Journal of Hospital Infection

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Community-onset healthcare-associated MRSA bacteraemia in a district general hospital

Karas

Enoch

Emery

2006

Journal of Hospital Infection

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“…CA-MRSA isolates primarily cause skin and soft tissue infections (SSTIs), but invasive infections such as bacteremia and necrotizing pneumonia have also been reported (10,19). CA-MRSA clones have traditionally been characterized based on pulsedfield gel electrophoresis (PFGE) typing and named according to their geographic distribution, e.g., South Pacific CA-MRSA, USA300 and USA400 CA-MRSA clones, etc.…”

mentioning

confidence: 99%

Epidemiology of European Community-Associated Methicillin-Resistant Staphylococcus aureus Clonal Complex 80 Type IV Strains Isolated in Denmark from 1993 to 2004

et al. 2008

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In Europe, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been caused predominantly by isolates belonging to the "European CA-MRSA" clone (sequence type 80, staphylococcal cassette chromosome mec type IV). In this study, the epidemiology of European CA-MRSA was investigated on a nationwide scale, covering the period from 1993 to 2004. Denmark has been a low-prevalence country regarding MRSA since the mid-1970s but has experienced an increase in the number of new MRSA cases in recent years. Our results show that European CA-MRSA contributed to this increase. The isolates primarily caused skin and soft tissue infections (SSTIs) in patients outside hospitals, and transmission between household members was the predominant mode of spread. Although some of the isolates were found in hospitalized patients, nosocomial transmission seemed likely in only one instance, pointing to endogenous infections as an important factor. Compared to the CA-MRSA clone most common in the United States (USA300), the European CA-MRSA clone seems less well adapted to persist in hospital environments. Patients with a recent history of travel or family relation to the Mediterranean or Middle East were highly overrepresented. The epidemiological data indicated that the European CA-MRSA isolates were introduced into Denmark on multiple occasions, paralleled by an increasing level of genetic diversity of the isolates found during the study period. European CA-MRSA has previously been described as a rather uniform clone. However, we found pronounced, diverse pulsed-field gel electrophoresis subtypes, staphylococcal protein A gene (spa) types, and susceptibility patterns.

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“…Outbreaks have also been reported in prison inmates [16], in native populations (eg, American Indians [17]), the homeless, IDU [18], wrestlers [19], and men who have sex with men [20]. Despite the absence of direct or indirect exposure to an institutional health care setting in which MRSA is likely to be found for many of the patients in these reported outbreaks of CA-MRSA [21,22,23•] and the consequent media attention, several studies have documented that CA-MRSA are frequently associated with some prior contact with a health care setting, such as nursing homes, hemodialysis centers, HIV/AIDS clinics, and hospitals, where antibiotic usage is likely to favor their persistence [24][25][26][27][28][29][30]. Indeed, the prevalence of truly CA-MRSA in persons without any trace of prior health care contacts is likely to be relatively low [2•,27,30,31,32•].…”

Section: Molecular Basis For Methicillin Resistancementioning

confidence: 99%

Community-associated methicillin-resistant Staphylococcus aureus: Reconsideration of therapeutic options

Levison

Fung²

2006

Curr Infect Dis Rep

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Methicillin resistance, long recognized as characteristic of nosocomial Staphylococcus aureus, has increasingly been identified in community-acquired strains in the past 15 years. The genotypes of community-associated methicillin-resistant S. aureus (MRSA) are different from nosocomial strains, and unlike nosocomial strains, they have a distinctive methicillin-resistance chromosomal cassette (designated type IV), are usually susceptible to multiple classes of antimicrobials other than beta-lactams, carry a distinctive virulence factor (the Panton-Valentine leukocidin), cause mainly skin and soft tissue infection and less frequently, necrotizing pneumonia, and involve predominantly children and young adults. Outbreaks have been reported in certain segments of the population (eg, football players, wrestlers, prison inmates, and native people) that often do not have the established risk factors for MRSA. However, these strains have also caused infections likely acquired in an institutional health care setting. Delay in starting appropriate antibiotic therapy for severe infections caused by MRSA can be life-threatening. This requires a reconsideration of the empiric choice of an anti-staphylococcal beta-lactam for seriously ill patients with suspected community-associated S. aureus infections.

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Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia

Cited by 37 publications

References 19 publications

Community-onset healthcare-associated MRSA bacteraemia in a district general hospital

Community-onset healthcare-associated MRSA bacteraemia in a district general hospital

Epidemiology of European Community-Associated Methicillin-Resistant Staphylococcus aureus Clonal Complex 80 Type IV Strains Isolated in Denmark from 1993 to 2004

Community-associated methicillin-resistant Staphylococcus aureus: Reconsideration of therapeutic options

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