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

  • J. O. Robinson
  • J. C. Pearson
  • K. J. Christiansen
  • G. W. Coombs
  • R. J. Murray
Article
First Online:
Received:
Accepted:

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.

Keywords

Infective Endocarditis Glycopeptide Positive Blood Culture Empiric Therapy Simplified Acute Physiology Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Notes

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.

References

  1. 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 PubMedCrossRefGoogle Scholar
  2. 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):241–247PubMedGoogle Scholar
  3. 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):2858–2862PubMedGoogle Scholar
  4. 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):236–242PubMedCrossRefGoogle Scholar
  5. 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 PubMedCrossRefGoogle Scholar
  6. 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):325–329PubMedGoogle Scholar
  7. 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 PubMedCrossRefGoogle Scholar
  8. 8.
    Peleg AY, Munckhof WJ (2004) Fatal necrotising pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Med J Aust 181(4):228–229PubMedGoogle Scholar
  9. 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):894–899PubMedGoogle Scholar
  10. 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 PubMedCrossRefGoogle Scholar
  11. 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 PubMedCrossRefGoogle Scholar
  12. 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 PubMedCrossRefGoogle Scholar
  13. 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 PubMedCrossRefGoogle Scholar
  14. 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 PubMedCrossRefGoogle Scholar
  15. 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 PubMedCrossRefGoogle Scholar
  16. 16.
    Garner JS, Jarus WR, Emori TG, Horan TC, Huges JM (1996) CDC definitions for nosocomial infections. Olmsted RN, St. Louis, pp A1–A20Google Scholar
  17. 17.
    Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically (2006) —7th edn: approved standard M7-A7., Wayne PA, USAGoogle Scholar
  18. 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 PubMedCrossRefGoogle Scholar
  19. 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 PubMedCrossRefGoogle Scholar
  20. 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):1642–1645PubMedGoogle Scholar
  21. 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):1008–1015PubMedGoogle Scholar
  22. 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 PubMedCrossRefGoogle Scholar
  23. 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 PubMedCrossRefGoogle Scholar
  24. 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 PubMedCrossRefGoogle Scholar
  25. 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 PubMedCrossRefGoogle Scholar
  26. 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 PubMedCrossRefGoogle Scholar
  27. 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 PubMedCrossRefGoogle Scholar
  28. 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 PubMedCrossRefGoogle Scholar
  29. 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 PubMedCrossRefGoogle Scholar
  30. 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 PubMedCrossRefGoogle Scholar
  31. 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 PubMedCrossRefGoogle Scholar
  32. 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 PubMedCrossRefGoogle Scholar
  33. 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 PubMedCrossRefGoogle Scholar
  34. 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):1584–1590PubMedGoogle Scholar
  35. 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 PubMedCrossRefGoogle Scholar
  36. 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 PubMedCrossRefGoogle Scholar
  37. 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 PubMedCrossRefGoogle Scholar
  38. 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

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J. O. Robinson
    • 1
  • J. C. Pearson
    • 1
  • K. J. Christiansen
    • 1
    • 2
  • G. W. Coombs
    • 1
    • 2
  • R. J. Murray
    • 1
  1. 1.Department of Microbiology and Infectious DiseasesPathWest Laboratory Medicine, Royal Perth HospitalPerthWestern Australia
  2. 2.Gram-positive Bacteria Typing and Research Unit, School of Biomedical SciencesCurtin University of TechnologyPerthWestern Australia

Personalised recommendations