Journal Article

Are Community-Associated Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) Strains Replacing Traditional Nosocomial MRSA Strains?

Kyle J. Popovich, Robert A. Weinstein and Bala Hota

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 6, pages 787-794
Published in print March 2008 | ISSN: 1058-4838
Published online March 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/528716
Are Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Replacing Traditional Nosocomial MRSA Strains?

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Background. Recent studies have suggested that community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection is encroaching on health care settings. We describe the epidemiology of hospital-onset community-associated MRSA bloodstream infections using phenotypic and genotypic analysis.

Methods. Using an update of an established rule derived from antibiotic susceptibilities, we inferred genotypes (i.e., community [CG] or hospital [HG]) for 208 MRSA isolates from hospital-onset (>72 h after hospital admission) bloodstream infections during 2000–2006. We compared demographic characteristics, risk factors, and outcomes of patients infected with CG or HG strains.

Results. Total hospital-onset MRSA bloodstream infection incidence density rates for the periods January 2000–June 2003 and July 2003–December 2006 (0.215 cases per 1000 patient-days and 0.207 cases per 1000 patient-days, respectively) were stable (risk ratio, 1.0; 95% confidence interval, 0.7–1.3; P=.79, period 2 vs. period 1). However, the risk that these bloodstream infections were due to CG strains doubled (risk ratio, 1.9; 95% confidence interval, 1.2–3.1; P=.01), whereas the risk due to HG strains decreased (risk ratio, 0.7; 95% confidence interval, 0.46–0.93; P=.02). After adjustment for comorbidities in multivariate analysis, no significant risk factors for or outcomes of infections due to CG versus HG strains were detected. Patients infected with HG strains showed a trend toward later day of acquisition of a positive blood culture, and those infected with CG strains showed trend toward greater risk of intensive care unit admission.

Conclusion. Although total hospital-onset MRSA bloodstream infection rates were relatively stable during 2000–2006, CG strains were responsible for an increasing proportion of cases (from 24% to 49%), suggesting replacement of traditional hospital-associated strains. For most risk factors and outcomes, patients infected with CG and HG strains were similar, suggesting that, thus far, CG strains are behaving like their traditional hospital-associated counterparts.

Journal Article.  4353 words.  Illustrated.

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

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