Journal Article

Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant <i>Staphylococcus aureus</i> and Methicillin-Susceptible <i>S. aureus</i>

Jiun-Ling Wang, Shey-Ying Chen, Jann-Tay Wang, Grace Hui-Min Wu, Wen-Chu Chiang, Po-Ren Hsueh, Yee-Chun Chen and Shan-Chwen Chang

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 6, pages 799-806
Published in print March 2008 | ISSN: 1058-4838
Published online March 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/527389
Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus

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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.

Journal Article.  4079 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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