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Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients.
J Infect 2007; 54(5):427-34JI

Abstract

BACKGROUND

We sought to determine the proportion of community-associated Staphylococcus aureus infections due to methicillin-resistant S. aureus (CA-MRSA) at a large county hospital. In addition, we sought to identify the demographic and clinical risk factors associated with CA-MRSA infection.

METHODS

Patients were prospectively enrolled if they were admitted to Parkland Hospital and had a positive culture for S. aureus isolated within 72 h of admission. The patients were interviewed using a standardized data questionnaire. Data collected included patient demographics, clinical history, as well as health care and non-health care associated MRSA risk factors. Bacterial susceptibilities were verified through review of microbiology laboratory and pharmacy records. Isolates were tested for Panton-Valentine leukocidin (PVL) gene, SCCmec type, and for inducible clindamycin resistance.

RESULTS

One hundred and ninety-eight patients were interviewed prospectively, of which eight had colonization without active infection. One hundred and nineteen patients were infected with MRSA and 71 patients were infected with methicillin-susceptible S. aureus (MSSA). Patients with MRSA were more likely to be African-American and unemployed. Patients with MRSA most commonly presented with a skin or soft tissue infection (SSTI): 69% versus 45%, p=0.0012, while patients with MSSA were more likely to have infection of the respiratory tract: 11% versus 3%, p=0.02. Patients with MRSA were more likely to have used antibiotics in the past six months, been homeless, have a history of incarceration, have abused alcohol and have a history of infection with MRSA. In multivariate analysis, African-American race, antibiotics in the past six months, and a history of being homeless were associated with MRSA infection. Only 11 of 119 (9%) MRSA patients did not have at least one of these risk factors. PVL gene was present in 72 of 74 (97%) MRSA isolates and SCCmec type IV was present in 63 of 75 (84%) MRSA isolates.

CONCLUSIONS

The majority of patients hospitalized with community-associated S. aureus infections were due to MRSA, most of which involved an SSTI. African-American race, recent antibiotics and past homeless status predicted infection with MRSA; however, no clinical profile could reliably exclude MRSA. Clinicians should be aware of the increasing prevalence of CA-MRSA.

Authors+Show Affiliations

The University of Texas Southwestern Medical Center, Dallas, TX, USA. daniel.skiest@bhs.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17070598

Citation

Skiest, Daniel J., et al. "Prospective Comparison of Methicillin-susceptible and Methicillin-resistant Community-associated Staphylococcus Aureus Infections in Hospitalized Patients." The Journal of Infection, vol. 54, no. 5, 2007, pp. 427-34.
Skiest DJ, Brown K, Cooper TW, et al. Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. J Infect. 2007;54(5):427-34.
Skiest, D. J., Brown, K., Cooper, T. W., Hoffman-Roberts, H., Mussa, H. R., & Elliott, A. C. (2007). Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. The Journal of Infection, 54(5), pp. 427-34.
Skiest DJ, et al. Prospective Comparison of Methicillin-susceptible and Methicillin-resistant Community-associated Staphylococcus Aureus Infections in Hospitalized Patients. J Infect. 2007;54(5):427-34. PubMed PMID: 17070598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. AU - Skiest,Daniel J, AU - Brown,Katia, AU - Cooper,Travis W, AU - Hoffman-Roberts,Holly, AU - Mussa,Huda R, AU - Elliott,Alan C, Y1 - 2006/10/27/ PY - 2006/06/30/received PY - 2006/08/21/revised PY - 2006/09/13/accepted PY - 2006/10/31/pubmed PY - 2007/5/26/medline PY - 2006/10/31/entrez SP - 427 EP - 34 JF - The Journal of infection JO - J. Infect. VL - 54 IS - 5 N2 - BACKGROUND: We sought to determine the proportion of community-associated Staphylococcus aureus infections due to methicillin-resistant S. aureus (CA-MRSA) at a large county hospital. In addition, we sought to identify the demographic and clinical risk factors associated with CA-MRSA infection. METHODS: Patients were prospectively enrolled if they were admitted to Parkland Hospital and had a positive culture for S. aureus isolated within 72 h of admission. The patients were interviewed using a standardized data questionnaire. Data collected included patient demographics, clinical history, as well as health care and non-health care associated MRSA risk factors. Bacterial susceptibilities were verified through review of microbiology laboratory and pharmacy records. Isolates were tested for Panton-Valentine leukocidin (PVL) gene, SCCmec type, and for inducible clindamycin resistance. RESULTS: One hundred and ninety-eight patients were interviewed prospectively, of which eight had colonization without active infection. One hundred and nineteen patients were infected with MRSA and 71 patients were infected with methicillin-susceptible S. aureus (MSSA). Patients with MRSA were more likely to be African-American and unemployed. Patients with MRSA most commonly presented with a skin or soft tissue infection (SSTI): 69% versus 45%, p=0.0012, while patients with MSSA were more likely to have infection of the respiratory tract: 11% versus 3%, p=0.02. Patients with MRSA were more likely to have used antibiotics in the past six months, been homeless, have a history of incarceration, have abused alcohol and have a history of infection with MRSA. In multivariate analysis, African-American race, antibiotics in the past six months, and a history of being homeless were associated with MRSA infection. Only 11 of 119 (9%) MRSA patients did not have at least one of these risk factors. PVL gene was present in 72 of 74 (97%) MRSA isolates and SCCmec type IV was present in 63 of 75 (84%) MRSA isolates. CONCLUSIONS: The majority of patients hospitalized with community-associated S. aureus infections were due to MRSA, most of which involved an SSTI. African-American race, recent antibiotics and past homeless status predicted infection with MRSA; however, no clinical profile could reliably exclude MRSA. Clinicians should be aware of the increasing prevalence of CA-MRSA. SN - 1532-2742 UR - https://www.unboundmedicine.com/medline/citation/17070598/Prospective_comparison_of_methicillin_susceptible_and_methicillin_resistant_community_associated_Staphylococcus_aureus_infections_in_hospitalized_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(06)00294-5 DB - PRIME DP - Unbound Medicine ER -