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15 March 2008

Volume 46, Number 6
Clinical Infectious Diseases 2008;46:799–806
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4606-0003$15.00
DOI: 10.1086/527389
MAJOR ARTICLE

Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community‐Acquired Methicillin‐Resistant Staphylococcus aureus and Methicillin‐Susceptible S. aureus

Jiun‐Ling Wang,1

Shey‐Ying Chen,2

Jann‐Tay Wang,1

Grace Hui‐Min Wu,4,5

Wen‐Chu Chiang,2

Po‐Ren Hsueh,1,3

Yee‐Chun Chen,1 and

Shan‐Chwen Chang1

Departments of 1Internal Medicine, 2Emergency Medicine, and 3Laboratory Medicine, National Taiwan University Hospital, and 4Institute of Preventive Medicine and 5Centre of BioStatistics Consultation, College of Public Health, National Taiwan University, Taipei, Taiwan

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 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; ). 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.

Received 5 June 2007; accepted 31 October 2007; electronically published 11 February 2008.

Reprints or correspondence: Dr. Shan‐Chwen Chang, Div. of Infectious Diseases, Dept. of Internal Medicine, National Taiwan University Hospital, 7, Chung‐Shan S. Rd., Taipei, Taiwan 100 ().

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