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Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains?
Clin Infect Dis 2008; 46(6):787-94CI

Abstract

BACKGROUND

Recent studies have suggested that community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection is encroaching on health care settings. We describe the epidemiology of hospital-onset community-associated MRSA bloodstream infections using phenotypic and genotypic analysis.

METHODS

Using an update of an established rule derived from antibiotic susceptibilities, we inferred genotypes (i.e., community [CG] or hospital [HG]) for 208 MRSA isolates from hospital-onset (>72 h after hospital admission) bloodstream infections during 2000-2006. We compared demographic characteristics, risk factors, and outcomes of patients infected with CG or HG strains.

RESULTS

Total hospital-onset MRSA bloodstream infection incidence density rates for the periods January 2000-June 2003 and July 2003-December 2006 (0.215 cases per 1000 patient-days and 0.207 cases per 1000 patient-days, respectively) were stable (risk ratio, 1.0; 95% confidence interval, 0.7-1.3; P = .79, period 2 vs. period 1). However, the risk that these bloodstream infections were due to CG strains doubled (risk ratio, 1.9; 95% confidence interval, 1.2-3.1; P = .01), whereas the risk due to HG strains decreased (risk ratio, 0.7; 95% confidence interval, 0.46-0.93; P = .02). After adjustment for comorbidities in multivariate analysis, no significant risk factors for or outcomes of infections due to CG versus HG strains were detected. Patients infected with HG strains showed a trend toward later day of acquisition of a positive blood culture, and those infected with CG strains showed trend toward greater risk of intensive care unit admission.

CONCLUSION

Although total hospital-onset MRSA bloodstream infection rates were relatively stable during 2000-2006, CG strains were responsible for an increasing proportion of cases (from 24% to 49%), suggesting replacement of traditional hospital-associated strains. For most risk factors and outcomes, patients infected with CG and HG strains were similar, suggesting that, thus far, CG strains are behaving like their traditional hospital-associated counterparts.

Authors+Show Affiliations

Division of Infectious Disease, Department of Medicine, Rush University Medical Center, and Division of Infectious Disease, Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois 60612, USA. kyle_popovich@rush.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18266611

Citation

Popovich, Kyle J., et al. "Are Community-associated Methicillin-resistant Staphylococcus Aureus (MRSA) Strains Replacing Traditional Nosocomial MRSA Strains?" Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 46, no. 6, 2008, pp. 787-94.
Popovich KJ, Weinstein RA, Hota B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis. 2008;46(6):787-94.
Popovich, K. J., Weinstein, R. A., & Hota, B. (2008). Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 46(6), pp. 787-94. doi:10.1086/528716.
Popovich KJ, Weinstein RA, Hota B. Are Community-associated Methicillin-resistant Staphylococcus Aureus (MRSA) Strains Replacing Traditional Nosocomial MRSA Strains. Clin Infect Dis. 2008 Mar 15;46(6):787-94. PubMed PMID: 18266611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? AU - Popovich,Kyle J, AU - Weinstein,Robert A, AU - Hota,Bala, PY - 2008/2/13/pubmed PY - 2008/3/19/medline PY - 2008/2/13/entrez SP - 787 EP - 94 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 46 IS - 6 N2 - BACKGROUND: Recent studies have suggested that community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection is encroaching on health care settings. We describe the epidemiology of hospital-onset community-associated MRSA bloodstream infections using phenotypic and genotypic analysis. METHODS: Using an update of an established rule derived from antibiotic susceptibilities, we inferred genotypes (i.e., community [CG] or hospital [HG]) for 208 MRSA isolates from hospital-onset (>72 h after hospital admission) bloodstream infections during 2000-2006. We compared demographic characteristics, risk factors, and outcomes of patients infected with CG or HG strains. RESULTS: Total hospital-onset MRSA bloodstream infection incidence density rates for the periods January 2000-June 2003 and July 2003-December 2006 (0.215 cases per 1000 patient-days and 0.207 cases per 1000 patient-days, respectively) were stable (risk ratio, 1.0; 95% confidence interval, 0.7-1.3; P = .79, period 2 vs. period 1). However, the risk that these bloodstream infections were due to CG strains doubled (risk ratio, 1.9; 95% confidence interval, 1.2-3.1; P = .01), whereas the risk due to HG strains decreased (risk ratio, 0.7; 95% confidence interval, 0.46-0.93; P = .02). After adjustment for comorbidities in multivariate analysis, no significant risk factors for or outcomes of infections due to CG versus HG strains were detected. Patients infected with HG strains showed a trend toward later day of acquisition of a positive blood culture, and those infected with CG strains showed trend toward greater risk of intensive care unit admission. CONCLUSION: Although total hospital-onset MRSA bloodstream infection rates were relatively stable during 2000-2006, CG strains were responsible for an increasing proportion of cases (from 24% to 49%), suggesting replacement of traditional hospital-associated strains. For most risk factors and outcomes, patients infected with CG and HG strains were similar, suggesting that, thus far, CG strains are behaving like their traditional hospital-associated counterparts. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18266611/Are_community_associated_methicillin_resistant_Staphylococcus_aureus__MRSA__strains_replacing_traditional_nosocomial_MRSA_strains L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/528716 DB - PRIME DP - Unbound Medicine ER -