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Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation.
Clin Infect Dis. 2007 Feb 15; 44(4):471-82.CI

Abstract

BACKGROUND

Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach.

METHODS

We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information.

RESULTS

Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60%) had MRSA infection, and 78 (40%) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P<.0001); skin/soft-tissue infection (P=.015); snorting/smoking illegal drugs (P=.01); recent incarceration (P=.03); lower comorbidity index (P=.01); more frequent visits to bars, raves, and/or clubs (P=.03); and higher frequency of laundering clothes in hot water (P=.05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10% (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7% posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous.

CONCLUSIONS

We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control.

Authors+Show Affiliations

Division of Infectious Diseases, Harbor-University of California-Los Angeles (UCLA) Medical Center, Torrance, CA 90509, USA. lgmiller@ucla.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

17243048

Citation

Miller, Loren G., et al. "Clinical and Epidemiologic Characteristics Cannot Distinguish Community-associated Methicillin-resistant Staphylococcus Aureus Infection From Methicillin-susceptible S. Aureus Infection: a Prospective Investigation." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 44, no. 4, 2007, pp. 471-82.
Miller LG, Perdreau-Remington F, Bayer AS, et al. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis. 2007;44(4):471-82.
Miller, L. G., Perdreau-Remington, F., Bayer, A. S., Diep, B., Tan, N., Bharadwa, K., Tsui, J., Perlroth, J., Shay, A., Tagudar, G., Ibebuogu, U., & Spellberg, B. (2007). Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 44(4), 471-82.
Miller LG, et al. Clinical and Epidemiologic Characteristics Cannot Distinguish Community-associated Methicillin-resistant Staphylococcus Aureus Infection From Methicillin-susceptible S. Aureus Infection: a Prospective Investigation. Clin Infect Dis. 2007 Feb 15;44(4):471-82. PubMed PMID: 17243048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. AU - Miller,Loren G, AU - Perdreau-Remington,Franciose, AU - Bayer,Arnold S, AU - Diep,Binh, AU - Tan,Nelly, AU - Bharadwa,Kiran, AU - Tsui,Jennifer, AU - Perlroth,Joshua, AU - Shay,Anthony, AU - Tagudar,Grace, AU - Ibebuogu,Uzoma, AU - Spellberg,Brad, Y1 - 2007/01/19/ PY - 2006/08/04/received PY - 2006/11/06/accepted PY - 2007/1/24/pubmed PY - 2007/3/1/medline PY - 2007/1/24/entrez SP - 471 EP - 82 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 44 IS - 4 N2 - BACKGROUND: Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach. METHODS: We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information. RESULTS: Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60%) had MRSA infection, and 78 (40%) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P<.0001); skin/soft-tissue infection (P=.015); snorting/smoking illegal drugs (P=.01); recent incarceration (P=.03); lower comorbidity index (P=.01); more frequent visits to bars, raves, and/or clubs (P=.03); and higher frequency of laundering clothes in hot water (P=.05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10% (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7% posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous. CONCLUSIONS: We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17243048/Clinical_and_epidemiologic_characteristics_cannot_distinguish_community_associated_methicillin_resistant_Staphylococcus_aureus_infection_from_methicillin_susceptible_S__aureus_infection:_a_prospective_investigation_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/511033 DB - PRIME DP - Unbound Medicine ER -