Clinical features and risk factors of mortality for bacteremia due to community-onset healthcare-associated methicillin-resistant S. aureus

Lee, Sai-Cheong; Lee, Chao‐Wei; Shih, Hsuan‐Jen; Chiou, Meng-Jiun; See, Lai‐Chu; Siu, L. Kristopher

doi:10.1016/j.diagmicrobio.2013.01.017

Cited by 14 publications

(17 citation statements)

References 31 publications

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“…The majority of the hemodialysis patients were community onset with a history of hospitalization in the prior year (24,25). In a multivariate analysis, chronic renal failure was identified as a significant factor in HACO-MRSA BSI cases (26). Our data also showed that patients with HACO-MRSA had significantly higher incidences of renal failure and hemodialysis.…”

Section: Discussionsupporting

confidence: 71%

“…Fortunately, hemodialysis was not a significant factor associated with mortality (P ϭ 0.071; OR, 1.86; CI, 0.95 to 3.65) ( Table 2). Molecular strain differences of SCCmec types between HA-MRSA and CA-MRSA have been observed (24,26). We did not observe differences in hemodialysis patients in SCCmec type comparisons, but there were differences among rep-PCR patterns ranging from 0 to 44%.…”

Section: Discussionmentioning

confidence: 62%

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Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

et al. 2015

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Historically, HA-MRSA and CA-MRSA could be clearly distinguished by clinical characteristics, antibiotic resistance patterns, and molecular typing (2). Well-described HA-MRSA risk factors for infection include a history of hospitalization, intravenous catheters, previous MRSA infections, residence in a long-termcare facility (LTCF), or surgery (3). CA-MRSA strains were detected mostly in younger patients, often associated with skin and soft-tissue infections, and tended to be less resistant to non-␤-lactam antibiotics (2). In the United States, the major genotype for HA-MRSA is pulsed-field gel electrophoresis (PFGE) USA100, clonal complex 5 (CC5), and staphylococcal cassette chromosome mec type II (SCCmec II), and for CA-MRSA the major genotype is PFGE USA300, CC8, and SCCmec IV (4). Recently, genotyping studies have shown that traditional CA-MRSA strains are increasingly associated with infections in hospitals, and conversely, traditional HA-MRSA strains have been reported in community patients with no HA risk factors (2,5,6). Genotyping studies also have shown that certain strains of S. aureus may be more likely to cause invasive infections or bacteremia than colonization (7).Since 2005, the Emerging Infection Program-Active Bacterial Core surveillance system (EIP-ABCs) of the Centers for Disease Control and Prevention (CDC) has been tracking MRSA infections in 9 U.S. cities and estimating the national burden of invasive MRSA infections (8, 9). From 2005 to 2011, the total number of MRSA invasive infections has decreased, but the proportion of community onset infections has increased since 2011 (8). Of the estimated 80,461 invasive MRSA infections that occurred in the United States in 2011, 18% were HAHO-MRSA, 60% were HACO-MRSA, and 21% were CA-MRSA (8, 10). MRSA bloodstream infection (BSI) has been the largest category of invasive MRSA disease, comprising 80% of the infections in 2011 (7,8,10).As described above, distinct clinical and molecular differences between HA-MRSA and CA-MRSA BSI have been shown, but very little is known regarding differences between HAHO-and HACO-MRSA BSI. Several important questions arise. Are there distinct clinical features that differentiate between MRSA BSI strains associated with HAHO-and HACO-MRSA cases not previously recognized, and are these clinical traits due to distinct

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 62%

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

et al. 2015

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“…In HACO MRSA isolates, SCC mec ‐II and ‐III strains were found to be present together with SCC mec ‐IV and ‐V strains . In our study, eight of nine HACO MRSA strains were classified as SCC mec ‐II, and 40% of the mutant MRSA strains were isolated within 48 h of admission.…”

Section: Discussionsupporting

confidence: 46%

“…Taken together, these findings suggested that the product of psm-mec may be involved in clinical characteristics but does not contribute to mortality. In HACO MRSA isolates, SCCmec-II and -III strains were found to be present together with SCCmec -IV and -V strains [27,28]. In our study, eight of nine HACO MRSA strains were classified as SCCmec-II, and 40% of the mutant MRSA strains were isolated within 48 h of admission.…”

Section: Discussionsupporting

confidence: 44%

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Impact of psm-mec in the mobile genetic element on the clinical characteristics and outcome of SCCmec-II methicillin-resistant Staphylococcus aureus bacteraemia in Japan

Aoyagi

Kaito

Sekimizu

et al. 2014

Clinical Microbiology and Infection

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Over-expression of alpha-phenol-soluble modulins (PSMs) results in high virulence of community-associated methicillin-resistant Staphylococcus aureus (MRSA). The psm-mec gene, located in the mobile genetic element SCCmec-II, suppresses PSMαs production. Fifty-two patients with MRSA bacteraemia were enrolled. MRSA isolates were evaluated with regard to the psm-mec gene sequence, bacterial virulence, and the minimum inhibitory concentration (MIC) of vancomycin and teicoplanin. Fifty-one MRSA isolates were classified as SCCmec-II, and 10 had one point mutation in the psm-mec promoter. We compared clinical characteristics and outcomes between mutant MRSA and wild-type MRSA. Production of PSMα3 in mutant MRSA was significantly increased, but biofilm formation was suppressed. Wild-type MRSA caused more catheter-related bloodstream infections (30/41 vs. 3/10, p 0.0028), whereas mutant MRSA formed more deep abscesses (4/10 vs. 3/41, p 0.035). Bacteraemia caused by mutant MRSA was associated with reduced 30-day mortality (1/10 vs. 13/41, p 0.25), although this difference was not significant. The MIC90 of teicoplanin was higher for wild-type MRSA (1.5 mg/L vs. 1 mg/L), but the MIC of vancomycin was not different between the two groups. The 30-day mortality of MRSA with a high MIC of teicoplanin (≥1.5 mg/L) was higher than that of strains with a lower MIC (≤0.75 mg/L) (6/10 vs. 6/33, p 0.017). Mutation of the psm-mec promoter contributes to virulence of SCCmec-II MRSA, and the product of psm-mec may determine the clinical characteristics of bacteraemia caused by SCCmec-II MRSA, but it does not affect mortality.

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A new simplified predictive model for mortality in methicillin-resistant Staphylococcus aureus bacteremia

Jorgensen

Lagnf

Bhatia

et al. 2019

Eur J Clin Microbiol Infect Dis

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Clinical features and risk factors of mortality for bacteremia due to community-onset healthcare-associated methicillin-resistant S. aureus

Cited by 14 publications

References 31 publications

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

Impact of psm-mec in the mobile genetic element on the clinical characteristics and outcome of SCCmec-II methicillin-resistant Staphylococcus aureus bacteraemia in Japan

A new simplified predictive model for mortality in methicillin-resistant Staphylococcus aureus bacteremia

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