Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus
Journal
Clinical Infectious Diseases
Journal Volume
46
Journal Issue
6
Pages
799-806
Date Issued
2008
Author(s)
Wang J.-L.
Wu G.H.-M.
Abstract
Background. The majority of research about community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has focused on skin and soft-tissue infections. No literature has been published on the clinical features and outcomes of adult patients with CA-MRSA bacteremia in comparison with patients with community-acquired methicillin-susceptible S. aureus (CA-MSSA) bacteremia. Methods. From 1 January 2001 through 31 December 2006, the demographic data and outcome of 215 consecutive adult patients admitted to a tertiary care center in Taiwan with S. aureus bacteremia (age, >16 years) who fulfilled the criteria for community-acquired S. aureus bacteremia were collected for analysis. Results. The mean age (±SD) was 56.8 ± 20.5 years. There were 30 patients (14%) with CA-MRSA bacteremia and 185 (86%) patients with CA-MSSA bacteremia. Cutaneous abscess (odds ratio, 5.46; 95% confidence interval, 1.66-17.94) and necrotizing pneumonia (odds ratio, 24.81; 95% confidence interval, 2.63-234.03) were the independent predictors of CA-MRSA bacteremia; endovascular infection was the only independent predictor of CA-MSSA bacteremia. After Cox regression analysis, the independent significant risk factors for 30-day mortality included increased age, shock, and thrombocytopenia (<100,000 cells/μL). After adjustment, the day 30 mortality of patients with CA-MRSA bacteremia was not significantly higher than that of patients with CA-MSSA bacteremia (adjusted hazard ratio, 1.01; 95% confidence interval, 0.30-3.39; P = .986). Most (92%) of 25 available CA-MRSA isolates were multilocus sequence typing 59. Conclusions. The number of adult patients with CA-MRSA bacteremia increased with time, and the disease was associated with more necrotizing pneumonia and cutaneous abscess but less endovascular infection than was CA-MSSA bacteremia. Patients with CA-MRSA bacteremia did not have higher mortality than did patients with CA-MSSA, even though most of the patients with CA-MRSA bacteremia did not receive empirical glycopeptide therapy. ? 2008 by the Infectious Diseases Society of America. All rights reserved.
SDGs
Other Subjects
amikacin; antiinfective agent; beta lactam; cefazolin; ciprofloxacin; clindamycin; cotrimoxazole; doxycycline; gentamicin; glycopeptide; levofloxacin; minocycline; oxacillin; rifampicin; tetracycline; vancomycin; antiinfective agent; meticillin; adult; aged; antibiotic sensitivity; article; bacteremia; bacterium isolate; clinical feature; controlled study; female; hospital admission; human; major clinical study; male; methicillin resistant Staphylococcus aureus; mortality; nonhuman; outcome assessment; pathogenesis; pneumonia; priority journal; prognosis; risk assessment; risk factor; sequence analysis; shock; skin abscess; skin infection; soft tissue infection; Taiwan; tertiary health care; thrombocytopenia; vascular disease; bacteremia; communicable disease; comparative study; drug effect; microbiology; middle aged; pathogenicity; pathophysiology; penicillin resistance; Staphylococcus aureus; Staphylococcus infection; Taiwan; university hospital; Adult; Aged; Anti-Bacterial Agents; Bacteremia; Community-Acquired Infections; Female; Hospitals, University; Humans; Male; Methicillin; Methicillin Resistance; Middle Aged; Prognosis; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Taiwan
Type
journal article