Skip to main content
SpringerLink
Log in

Predicting methicillin resistance among community-onset Staphylococcus aureus bacteremia patients with prior healthcare-associated exposure

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

Abstract

To develop and validate prediction rules to identify the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among community patients who have healthcare-associated (HA) exposure and S. aureus bacteremia. A total of 1,166 adults with community-onset S. aureus bacteremia were retrospectively enrolled. The background prevalence of community MRSA infection was extrapolated from 392 community-associated S. aureus bacteremia (CA-SAB) patients without HA exposure. Complete and clinical risk scores were derived and tested using data from 774 healthcare-associated S. aureus bacteremia (HA-SAB) patients. The risk scores were modeled with and without incorporating previous microbiological data as a model predictor and stratified patients to low-, intermediate-, and high-risk groups for MRSA infection. The clinical risk score included five independent predictors and the complete risk score included six independent predictors. The clinical and complete risk scores stratified 32.7 % and 42.0 % of HA-SAB patients to the low-risk group for MRSA infection respectively. The prevalence of MRSA infection in score-stratified low-risk groups ranged from 16.3 % to 23.3 %, comparable to that of CA-SAB patients (13.8 %). Simple decision rules allow physicians to stratify the risk of MRSA infection when treating community patients with prior HA exposure and possible S. aureus infection.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jevons MP (1961) “Celbenin”-resistant staphylococci. Br Med J 1:124–125

    Article  Google Scholar 

  2. Diekema DJ, BootsMiller BJ, Vaughn TE, Woolson RF, Yankey JW, Ernst EJ, Flach SD, Ward MM, Franciscus CL, Pfaller MA, Doebbeling BN (2004) Antimicrobial resistance trends and outbreak frequency in United States Hospitals. Clin Infect Dis 38:78–85

    Article  PubMed  Google Scholar 

  3. Hsueh PR, Teng LJ, Chen WH, Pan HJ, Chen ML, Chang SC, Luh KT, Lin FY (2004) Increasing prevalence of methicillin-resistant Staphylococcus aureus causing nosocomial infections at a university hospital in Taiwan from 1986 to 2001. Antimicrob Agents Chemother 48:1361–1364

    Article  PubMed  CAS  Google Scholar 

  4. Lescure FX, Biendo M, Douadi Y, Schmit JL, Eveillard M (2006) Changing epidemiology of methicillin-resistant Staphylococcus aureus and effects on cross-transmission in a teaching hospital. Eur J Clin Microbiol Infect Dis 25:205–207

    Article  PubMed  CAS  Google Scholar 

  5. Charlebois ED, Perdreau-Remington F, Kreiswirth B, Bangsberg DR, Ciccarone D, Diep BA, Ng VL, Chansky K, Edlin BR, Chambers HF (2004) Origins of community strains of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 39:47–54

    Article  PubMed  CAS  Google Scholar 

  6. Tacconelli E, Venkataraman L, De Girolami PC, Dagata EM (2004) Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains. J Antimicrob Chemother 53:474–479

    Article  PubMed  CAS  Google Scholar 

  7. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK (2007) Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 298:1763–1771

    Article  PubMed  CAS  Google Scholar 

  8. Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Noy A, Schwartz D, Giladi M (2002) Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis 34:1431–1439

    Article  PubMed  Google Scholar 

  9. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ (2002) Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 137:791–797

    PubMed  Google Scholar 

  10. Lubin AS, Snydman DR, Ruthazer R, Bide P, Golan Y (2011) Predicting high vancomycin minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus bloodstream infections. Clin Infect Dis 52:997–1002

    Article  PubMed  CAS  Google Scholar 

  11. Lodise TP, Miller CD, Graves J, Evans A, Graffunder E, Helmecke M, Stellrecht K (2008) Predictors of high vancomycin MIC values among patients with methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother 62:1138–1141

    Article  PubMed  CAS  Google Scholar 

  12. Pillai SK, Wennersten C, Venkataraman L, Eliopoulos GM, Moellering RC, Karchmer AW (2009) Development of reduced vancomycin susceptibility in methicillin-susceptible Staphylococcus aureus. Clin Infect Dis 49:1169–1174

    Article  PubMed  CAS  Google Scholar 

  13. Liao CH, Chen SY, Chang SC, Hsueh PR, Hung CC, Chen YC (2005) Characteristics of community-acquired and health care-associated Staphylococcus aureus bacteremia in patients treated at the emergency department of a teaching hospital. Diagn Microbiol Infect Dis 53:85–92

    Article  PubMed  Google Scholar 

  14. Wang JL, Wang JT, Chen SY, Hsueh PR, Kung HC, Chen YC, Chang SC (2007) Adult methicillin-resistant Staphylococcus aureus bacteremia in Taiwan: clinical significance of non-multi-resistant antibiogram and Panton-Valentine leukocidin gene. Diagn Microbiol Infect Dis 59:365–371

    Article  PubMed  CAS  Google Scholar 

  15. Laupacis A, Sekar N, Stiell IG (1997) Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 277:488–494

    Article  PubMed  CAS  Google Scholar 

  16. Shorr AF, Zilberberg MD, Micek ST, Kollef MH (2008) Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 168:2205–2210

    Article  PubMed  Google Scholar 

  17. Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, Micek ST, Kollef MH (2012) Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis 54:193–198

    Article  PubMed  Google Scholar 

  18. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA (2006) Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 355:666–674

    Article  PubMed  CAS  Google Scholar 

  19. King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM (2006) Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 144:309–317

    PubMed  Google Scholar 

  20. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA (2002) Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 162:2229–2235

    Article  PubMed  Google Scholar 

  21. 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 36:53–59

    Article  PubMed  Google Scholar 

  22. Salgado CD, Farr BM, Calfee DP (2003) Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis 36:131–139

    Article  PubMed  Google Scholar 

  23. Hota B, Lyles R, Rim J, Popovich KJ, Rice T, Aroutcheva A, Weinstein RA (2011) Predictors of clinical virulence in community-onset methicillin-resistant Staphylococcus aureus infections: the importance of USA300 and pneumonia. Clin Infect Dis 53:757–765

    Article  PubMed  Google Scholar 

  24. Chen SY, Wang JT, Chen TH, Lai MS, Chie WC, Chien KL, Hsueh PR, Wang JL, Chang SC (2010) Impact of traditional hospital strain of methicillin-resistant Staphylococcus aureus (MRSA) and community strain of MRSA on mortality in patients with community-onset S aureus bacteremia. Medicine (Baltimore) 89:285–294

    Article  CAS  Google Scholar 

  25. 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 29:1171–1177

    Article  PubMed  CAS  Google Scholar 

  26. Chang FY, Peacock JE Jr, Musher DM, Triplett P, MacDonald BB, Mylotte JM, O’Donnell A, Wagener MM, Yu VL (2003) Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore) 82:333–339

    Article  CAS  Google Scholar 

  27. Stryjewski ME, Szczech LA, Benjamin DK Jr, Inrig JK, Kanafani ZA, Engemann JJ, Chu VH, Joyce MJ, Reller LB, Corey GR, Fowler VG Jr (2007) Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis 44:190–196

    Article  PubMed  CAS  Google Scholar 

  28. Scanvic A, Denic L, Gaillon S, Giry P, Andremont A, Lucet JC (2001) Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 32:1393–1398

    Article  PubMed  CAS  Google Scholar 

  29. Chen SY, Wu GH, Chang SC, Hsueh PR, Chiang WC, Lee CC, Ma MH, Hung CC, Chen YC, Su CP, Tsai KC, Chen TH, Chen SC, Chen WJ (2008) Bacteremia in previously hospitalized patients: prolonged effect from previous hospitalization and risk factors for antimicrobial-resistant bacterial infections. Ann Emerg Med 51:639–646

    Article  PubMed  Google Scholar 

  30. Miller LG, Perdreau-Remington F, Bayer AS, 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. Clin Infect Dis 44:471–482

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Funding

This study did not receive any outside funding.

Conflicts of interest

All authors declare that they have no conflicts of interest.

Ethical approval

Institutional Review Board, National Taiwan University Hospital, Taipei, Taiwan.

Author information

Authors and Affiliations

  1. Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xuzhou Road, Zhongzheng District, Taipei, 100, Taiwan

    S.-Y. Chen, W.-C. Chiang, W.-C. Chie & M.-S. Lai

  2. Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    S.-Y. Chen, W.-C. Chiang, M. H.-M. Ma, C.-C. Fang, S.-C. Chen & W.-J. Chen

  3. Department of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    P.-R. Hsueh

  4. Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    S.-C. Chang

Authors
  1. S.-Y. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W.-C. Chiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. H.-M. Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P.-R. Hsueh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S.-C. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C.-C. Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S.-C. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W.-J. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. W.-C. Chie
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M.-S. Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.-S. Lai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, SY., Chiang, WC., Ma, M.HM. et al. Predicting methicillin resistance among community-onset Staphylococcus aureus bacteremia patients with prior healthcare-associated exposure. Eur J Clin Microbiol Infect Dis 31, 2727–2736 (2012). https://doi.org/10.1007/s10096-012-1621-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-012-1621-y

Keywords

Search

Navigation