4.4 Article

Clinical and Microbiological Characteristics of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Bacteremia Caused by a Community-Associated PVL-Negative Strain

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OPEN FORUM INFECTIOUS DISEASES
卷 8, 期 9, 页码 -

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OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofab424

关键词

bacteremia; hospital-acquired infection; methicillin-resistant Staphylococcus aureus; outcome; Panton-Valentine Leukocidin-negative

资金

  1. Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) - Ministry of Health & Welfare, Republic of Korea [HI15C2918]

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In Korea, the community-associated MRSA strain ST72-SCCmecIV has been found to cause a higher prevalence of osteoarticular infections in hospital-acquired cases, with patients being younger and less likely to have a history of recent surgery, antibiotic treatment, nasal MRSA colonization, and central venous catheter placement compared to the hospital-associated strain ST5-SCCmecII. Overall, there were no significant differences in mortality rates between the two groups.
Background. ST72-SCCmecIV, a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain in Korea, originated in the community and has been spreading in health care settings. Herein, we describe the clinical and microbiological characteristics of patients with hospital-acquired MRSA bacteremia (MRSAB) caused by community-associated strains. Methods. We analyzed hospital-acquired MRSAB cases caused by ST72-SCCmecIV using a prospective cohort of patients with SAB in a tertiary hospital in Korea from July 2008 to December 2018. We compared the clinical and microbiological characteristics of ST72-SCCmecIV with ST5-SCCmecII, a representative hospital-associated genotype strain. Results. Of the 1782 S. aureus bacteremia (SAB) cases, 628 (35.2%) were hospital-acquired MRSAB. Of the 628 isolates, 431 (68.6%) were ST5-SCCmecII and 152 (24.2%) were ST72-SCCmecIV. Patients with ST72-SCCmecIV were younger than those with ST5-SCCmecII and less likely to have a history of recent surgery, antibiotic treatment, nasal MRSA colonization, and central venous catheter placement. Compared with ST5-SCCmecII, ST72-SCCmecIV isolates were more likely to have vancomycin MICs <= 1.0 mg/L (P < .001). Osteoarticular infection as the site of infection (7.2% [11/152] vs 1.4% [6/431]) was more common in patients with ST72-SCCmecIV. There were no significant differences in the rate of recurrence (<= 90 days), persistent bacteremia (>= 7 days), or 30- and 90-day mortality rates between the 2 groups. Conclusions. Osteoarticular infections were more prevalent in ST72-SCCmecIV MRSAB. Mortality rates between the ST72-SCCmecIV and ST5-SCCmecII groups were not significantly different.

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