Journal Article

Methicillin-resistant <i>Staphylococcus aureus</i> bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains

E. Tacconelli, L. Venkataraman, P. C. De Girolami and E. M. C. D’Agata

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 53, issue 3, pages 474-479
Published in print March 2004 | ISSN: 0305-7453
Published online March 2004 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh107
Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections diagnosed at hospital admission are often referred to as community-acquired. This designation may include MRSA strains previously acquired in a healthcare setting (healthcare-associated) as well as those that have emerged from community-based S. aureus strains.

Methods: To understand further the epidemiology of MRSA from the community, a case-control study was performed. During 1997–2002, 254 patients with and without MRSA bacteraemia at hospital admission were studied.

Results: All patients with MRSA bacteraemia in the first 24 h of hospital admission had a recent exposure to a healthcare setting: true community-acquired MRSA was not detected. Independent risk factors for healthcare-associated MRSA bacteraemia, defined as MRSA bacteraemia in the first 24 h of hospital admission among patients with a recent exposure to a healthcare setting or intervention, included previous MRSA infection or colonization (OR = 17, P < 0.001), cellulitis (OR = 4, P = 0.006), presence of a central venous catheter (OR = 3, P < 0.001) and skin ulcers (OR = 3, P = 0.007).

Conclusions: In this study, MRSA bacteraemia diagnosed in the first 24 h of hospital admission represented healthcare-associated MRSA strains and not true community-acquired strains. The clinical characteristics associated with healthcare-associated MRSA bacteraemia can assist clinicians in targeting measures to prevent cross-transmission and may help to streamline empirical vancomycin therapy.

Keywords: Keywords: S. aureus, methicillin resistance, risk factors

Journal Article.  3998 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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