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Long-term methicillin-resistant Staphylococcus aureus bacteremia persisting for more than 2 weeks: risk factors and outcomes

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Abstract

The clinical significance of long-term methicillin-resistant Staphylococcus aureus (MRSA) bacteremia remains unclear. We evaluated the clinical, microbiological characteristics, and clinical outcomes of long-term MRSA bacteremia. A nested case-control study was conducted in a prospective cohort of adult patients with MRSA bacteremia at a tertiary hospital between August 2008 and December 2017. Patients with long-term MRSA bacteremia (≥ 14 days) were compared with control patients, defined as having bacteremia that resolved in less than 3 days. The following variables were documented: heteroresistance phenotype, genotypes, agr dysfunction, and the presence of 41 virulence genes in isolates. Of the total 890 patients studied, 69 patients (7.8%) exhibited long-term MRSA bacteremia and 599 (67.3%) exhibited resolving bacteremia. The most common sources of long-term bacteremia were central venous catheter–related infection (39%) and osteomyelitis (19%). Independent risk factors for long-term MRSA bacteremia included male sex (adjusted odds ratio [aOR] = 2.43), community-acquired bacteremia (aOR = 2.93), the presence of a prosthetic device (aOR = 3.40), and osteomyelitis (aOR = 7.98). Metastatic infections developed more frequently in patients with long-term bacteremia than in those with resolving bacteremia (56.5% vs. 8.0%; P < 0.001). Although there were no significant differences in 30-day, 12-week, or in-hospital mortality rates between the two groups, infection-attributable mortality was higher in the long-term bacteremia group (23.2% vs. 11.5%; P = 0.01). Microbiological characteristics did not differ significantly between the two groups. Clinical factors, including community-acquired bacteremia, the presence of a prosthetic device, and osteomyelitis, appear to contribute to long-term MRSA bacteremia more than microbiological factors.

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Funding

This research was supported by a grant from Korea Health Technology R&D Project through Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI15C2918).

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea

    Yu-Mi Lee & Ki-Ho Park

  2. Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Yong Pil Chong, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi & Jun Hee Woo

  3. Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Minjeong Kim & Yewon Eom

  4. Division of Infectious Diseases and Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan college of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Eun Sil Kim, Miyoung Kim & Yang Soo Kim

  5. Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea

    Eun Sil Kim, Miyoung Kim & Yang Soo Kim

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  1. Yu-Mi Lee
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  2. Yong Pil Chong
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  9. Sang-Oh Lee
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Correspondence to Yang Soo Kim.

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The study was approved by the Asan Medical Center Institutional Review Board (IRB).

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Lee, YM., Chong, Y.P., Kim, M. et al. Long-term methicillin-resistant Staphylococcus aureus bacteremia persisting for more than 2 weeks: risk factors and outcomes. Eur J Clin Microbiol Infect Dis 39, 773–781 (2020). https://doi.org/10.1007/s10096-019-03795-6

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  • DOI: https://doi.org/10.1007/s10096-019-03795-6

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