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

  • S.-Y. Chen
  • W.-C. Chiang
  • M. H.-M. Ma
  • P.-R. Hsueh
  • S.-C. Chang
  • C.-C. Fang
  • S.-C. Chen
  • W.-J. Chen
  • W.-C. Chie
  • M.-S. Lai


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.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • S.-Y. Chen
    • 1
    • 2
  • W.-C. Chiang
    • 1
    • 2
  • M. H.-M. Ma
    • 2
  • P.-R. Hsueh
    • 3
  • S.-C. Chang
    • 4
  • C.-C. Fang
    • 2
  • S.-C. Chen
    • 2
  • W.-J. Chen
    • 2
  • W.-C. Chie
    • 1
  • M.-S. Lai
    • 1
  1. 1.Graduate Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
  2. 2.Department of Emergency Medicine, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  3. 3.Department of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  4. 4.Department of Internal Medicine, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan

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