Skip to main content

Advertisement

SpringerLink
Log in

Community-associated versus healthcare-associated methicillin-resistant Staphylococcus aureus bacteraemia: a 10-year retrospective review

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The objective was to compare the epidemiology and outcome of healthcare- (HA-) and community-associated (CA-) MRSA bacteraemia. A 10-year retrospective study of MRSA bacteraemia was carried out. Episodes were classified according to established criteria. Molecular typing was performed on a subset of isolates. Of 197 MRSA bacteraemia episodes, 178 (90.4%) were classified as HA-MRSA and 19 (9.6%) as CA-MRSA. All-cause 7- and 30-day mortality rates were similar in the HA and CA-MRSA bacteraemia groups; however, 1-year mortality was higher in the HA-MRSA bacteraemia group (48.3% vs 21.1% [p = 0.023]). Thirty-day all-cause mortality was significantly lower if empiric antimicrobial therapy included agent(s) to which the isolate tested susceptible, compared with patients receiving “inactive” therapy (19% vs 35.1% [p = 0.011]). The majority of MRSA bacteraemia episodes were caused by clones known to circulate in the community. All-cause mortality is as high in HA- as in CA-MRSA bacteraemia. Thirty-day mortality was significantly reduced if the patient received an antibiotic with activity against the MRSA isolate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Udo EE, Pearman JW, Grubb WB (1993) Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect 25(2):97–108. doi:10.1016/0195–6701(93)90100-E

    Article  PubMed  CAS  Google Scholar 

  2. Coombs GW, Pearson JC, O’Brien FG, Murray RJ, Grubb WB, Christiansen KJ (2006) Methicillin-resistant Staphylococcus aureus clones, Western Australia. Emerg Infect Dis 12(2):241–247

    PubMed  Google Scholar 

  3. O’Brien FG, Pearman JW, Gracey M, Riley TV, Grubb WB (1999) Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 37(9):2858–2862

    PubMed  CAS  Google Scholar 

  4. Maree CL, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG (2007) Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 13(2):236–242

    Article  PubMed  Google Scholar 

  5. Lescure FX, Locher G, Eveillard M, Biendo M, Van Agt S, Le Loup G et al (2006) Community-acquired infection with healthcare-associated methicillin-resistant Staphylococcus aureus: the role of home nursing care. Infect Control Hosp Epidemiol 27(11):1213–1218. doi:10.1086/507920

    Article  PubMed  Google Scholar 

  6. Saravolatz LD, Pohlod DJ, Arking LM (1982) Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks. Ann Intern Med 97(3):325–329

    PubMed  CAS  Google Scholar 

  7. Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS et al (2005) Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 352(14):1445–1453. doi:10.1056/NEJMoa042683

    Article  PubMed  CAS  Google Scholar 

  8. Peleg AY, Munckhof WJ (2004) Fatal necrotising pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Med J Aust 181(4):228–229

    PubMed  Google Scholar 

  9. Hageman JC, Uyeki TM, Francis JS, Jernigan DB, Wheeler JG, Bridges CB et al (2006) Severe community-acquired pneumonia due to Staphylococcus aureus, 2003–04 influenza season. Emerg Infect Dis 12(6):894–899

    PubMed  Google Scholar 

  10. Murray RJ, Lim TT, Pearson JC, Grubb WB, Lum GD (2004) Community-onset methicillin-resistant Staphylococcus aureus bacteremia in Northern Australia. Int J Infect Dis 8(5):275–283. doi:10.1016/j.ijid.2003.11.008

    Article  PubMed  Google Scholar 

  11. Seybold U, Kourbatova EV, Johnson JG, Halvosa SJ, Wang YF, King MD et al (2006) Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 42(5):647–656. doi:10.1086/499815

    Article  PubMed  CAS  Google Scholar 

  12. Tsigrelis C, Armstrong MD, Vlahakis NE, Batsis JA, Baddour LM (2007) Infective endocarditis due to community-associated methicillin-resistant Staphylococcus aureus in injection drug users may be associated with Panton-Valentine leukocidin-negative strains. Scand J Infect Dis 39(4):299–302. doi:10.1080/00365540601003803

    Article  PubMed  Google Scholar 

  13. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270(24):2957–2963. doi:10.1001/jama.270.24.2957

    Article  PubMed  Google Scholar 

  14. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638. doi:10.1086/313753

    Article  PubMed  CAS  Google Scholar 

  15. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S et al (2007) Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 298(15):1763–1771. doi:10.1001/jama.298.15.1763

    Article  PubMed  CAS  Google Scholar 

  16. Garner JS, Jarus WR, Emori TG, Horan TC, Huges JM (1996) CDC definitions for nosocomial infections. Olmsted RN, St. Louis, pp A1–A20

    Google Scholar 

  17. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically (2006) —7th edn: approved standard M7-A7., Wayne PA, USA

  18. Costa AM, Kay I, Palladino S (2005) Rapid detection of mecA and nuc genes in staphylococci by real-time multiplex polymerase chain reaction. Diagn Microbiol Infect Dis 51(1):13–17. doi:10.1016/j.diagmicrobio.2004.08.014

    Article  PubMed  CAS  Google Scholar 

  19. McDougal LK, Steward CD, Killgore GE, Chaitram JM, McAllister SK, Tenover FC (2003) Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 41(11):5113–5120. doi:10.1128/JCM.41.11.5113–5120.2003

    Article  PubMed  CAS  Google Scholar 

  20. Goh SH, Byrne SK, Zhang JL, Chow AW (1992) Molecular typing of Staphylococcus aureus on the basis of coagulase gene polymorphisms. J Clin Microbiol 30(7):1642–1645

    PubMed  CAS  Google Scholar 

  21. Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG (2000) Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 38(3):1008–1015

    PubMed  CAS  Google Scholar 

  22. Ito T, Ma XX, Takeuchi F, Okuma K, Yuzawa H, Hiramatsu K (2004) Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC. Antimicrob Agents Chemother 48(7):2637–2651. doi:10.1128/AAC.48.7.2637–2651.2004

    Article  PubMed  CAS  Google Scholar 

  23. Lim TT, Chong FN, O’Brien FG, Grubb WB (2003) Are all community methicillin-resistant Staphylococcus aureus related? A comparison of their mec regions. Pathology 35(4):336–343. doi:10.1080/0031302031000150498

    Article  PubMed  Google Scholar 

  24. Okuma K, Iwakawa K, Turnidge JD, Grubb WB, Bell JM, O’Brien FG et al (2002) Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 40(11):4289–4294. doi:10.1128/JCM.40.11.4289–4294.2002

    Article  PubMed  CAS  Google Scholar 

  25. Enright MC, Robinson DA, Randle G, Feil EJ, Grundmann H, Spratt BG (2002) The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proc Natl Acad Sci USA 99(11):7687–7692. doi:10.1073/pnas.122108599

    Article  PubMed  CAS  Google Scholar 

  26. Peleg AY, Munckhof WJ, Kleinschmidt SL, Stephens AJ, Huygens F (2005) Life-threatening community-acquired methicillin-resistant Staphylococcus aureus infection in Australia. Eur J Clin Microbiol Infect Dis 24(6):384–387. doi:10.1007/s10096–005–1329–3

    Article  PubMed  CAS  Google Scholar 

  27. Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB et al (2003) Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 163(17):2066–2072. doi:10.1001/archinte.163.17.2066

    Article  PubMed  Google Scholar 

  28. Wyllie DH, Crook DW, Peto TE (2006) Mortality after Staphylococcus aureus bacteraemia in two hospitals in Oxfordshire, 1997–2003: cohort study. BMJ 333(7562):281. doi:10.1136/bmj.38834.421713.2F

    Article  PubMed  Google Scholar 

  29. Denniston S, Riordan FA (2006) Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review. J Infect 53(6):387–393. doi:10.1016/j.jinf.2005.11.185

    Article  PubMed  Google Scholar 

  30. Fatkenheuer G, Preuss M, Salzberger B, Schmeisser N, Cornely OA, Wisplinghoff H et al (2004) Long-term outcome and quality of care of patients with Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 23(3):157–162. doi:10.1007/s10096–003–1083–3

    Article  PubMed  CAS  Google Scholar 

  31. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y (2003) Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 36(1):53–59. doi:10.1086/345476

    Article  PubMed  Google Scholar 

  32. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB et al (2006) Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 355(7):666–674. doi:10.1056/NEJMoa055356

    Article  PubMed  CAS  Google Scholar 

  33. Popovich KJ, Weinstein RA, Hota B (2008) Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 46(6):787–794. doi:10.1086/528716

    Article  PubMed  Google Scholar 

  34. Dailey L, Coombs GW, O’Brien FG, Pearman JW, Christiansen K, Grubb WB et al (2005) Methicillin-resistant Staphylococcus aureus, Western Australia. Emerg Infect Dis 11(10):1584–1590

    PubMed  Google Scholar 

  35. Fang CT, Shau WY, Hsueh PR, Chen YC, Wang JT, Hung CC et al (2006) Early empirical glycopeptide therapy for patients with methicillin-resistant Staphylococcus aureus bacteraemia: impact on the outcome. J Antimicrob Chemother 57(3):511–519. doi:10.1093/jac/dkl006

    Article  PubMed  CAS  Google Scholar 

  36. Gonzalez C, Rubio M, Romero-Vivas J, Gonzalez M, Picazo JJ (1999) Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 29(5):1171–1177. doi:10.1086/313440

    Article  PubMed  CAS  Google Scholar 

  37. Soriano A, Marco F, Martinez JA, Pisos E, Almela M, Dimova VP et al (2008) Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 46(2):193–200. doi:10.1086/524667

    Article  PubMed  CAS  Google Scholar 

  38. Community prescription drug use, in DDS/1000/Day, for 2003 to 2005. Available from: http://www.pbs.gov.au/html/healthpro/factsheet/view?date=20070801&type=AcrobatPDF&name=asm-table-2&folder=pbs_statistics&area=professional. Cited 14/08/2008

Download references

Acknowledgements

We wish to thank Nicola Hill and Paulette Lee for their assistance in obtaining patient charts.

Conflict of interest

None.

Financial disclosure

This research was supported by the Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia.

Author information

Authors and Affiliations

  1. Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Royal Perth Hospital, Wellington Street, Perth, 6000, Western Australia

    J. O. Robinson, J. C. Pearson, K. J. Christiansen, G. W. Coombs & R. J. Murray

  2. Gram-positive Bacteria Typing and Research Unit, School of Biomedical Sciences, Curtin University of Technology, Perth, Western Australia

    K. J. Christiansen & G. W. Coombs

Authors
  1. J. O. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. C. Pearson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. J. Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. W. Coombs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. J. Murray
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. O. Robinson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Robinson, J.O., Pearson, J.C., Christiansen, K.J. et al. Community-associated versus healthcare-associated methicillin-resistant Staphylococcus aureus bacteraemia: a 10-year retrospective review. Eur J Clin Microbiol Infect Dis 28, 353–361 (2009). https://doi.org/10.1007/s10096-008-0632-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-008-0632-1

Keywords

Search

Navigation