Division of Infectious Disease, Department of Medicine, Rush University Medical Center, and Division of Infectious Disease, Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois
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; 
, 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; 
), whereas the risk due to HG strains decreased (risk ratio, 0.7; 95% confidence interval, 0.46–0.93; 
). 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.
Cited by
J. A. Otter, N. L. Havill, J. M. Boyce, G. L. French. (2009) Comparison of community-associated meticillin-resistant Staphylococcus aureus from teaching hospitals in London and the USA, 2004–2006: where is USA300 in the UK?.
European Journal of Clinical Microbiology & Infectious Diseases 28:7, 835-839
Online publication date: 1-Aug-2009.
CrossRef Rachel C. Orscheln, David A. Hunstad, Stephanie A. Fritz, Jennifer A. Loughman, Kimberly Mitchell, Emily K. Storch, Monique Gaudreault, Patricia L. Sellenriek, Jon R. Armstrong, Elaine R. Mardis, and Gregory A. Storch. Contribution of Genetically Restricted, Methicillin‐Susceptible Strains to the Ongoing Epidemic of Community‐Acquired
Staphylococcus aureus Infections.
Clinical Infectious Diseases 0:0, 000-000
Jeffrey S. Gerber, Susan E. Coffin, Sarah A. Smathers, and Theoklis E. Zaoutis. (2009) Trends in the Incidence of Methicillin‐Resistant
Staphylococcus aureus Infection in Children’s Hospitals in the United States.
Clinical Infectious Diseases 49:1, 65-71
Online publication date: 1-Jul-2009.
S. Burgassi, I. Zanardi, V. Travagli, E. Montomoli, V. Bocci. (2009) How much ozone bactericidal activity is compromised by plasma components?.
Journal of Applied Microbiology 106:5, 1715-1721
Online publication date: 1-Jun-2009.
CrossRef J. O. Robinson, J. C. Pearson, K. J. Christiansen, G. W. Coombs, R. J. Murray. (2009) Community-associated versus healthcare-associated methicillin-resistant Staphylococcus aureus bacteraemia: a 10-year retrospective review.
European Journal of Clinical Microbiology & Infectious Diseases 28:4, 353-361
Online publication date: 1-May-2009.
CrossRef P. Federspil, P.A. Federspil, U. Geipel. (2009) Methicillinresistente Staphylokokken (MRSA, MRSE) im Nasen-, Nasennebenhöhlenbereich und Sputum.
HNO 57:4, 395-407
Online publication date: 1-May-2009.
CrossRef R. Leclercq. (2009) Epidemiological and resistance issues in multidrug-resistant staphylococci and enterococci.
Clinical Microbiology and Infection 15:3, 224-231
Online publication date: 1-Apr-2009.
CrossRef Timothy C. Jenkins, MD; Bruce D. McCollister, MD; Rohini Sharma, MD; Kim K. McFann, PhD; Nancy E. Madinger, MD; Michelle Barron, MD; Mary Bessesen, MD; Connie S. Price, MD; William J. Burman, MD. (2009) Epidemiology of Healthcare‐Associated Bloodstream Infection Caused by USA300 Strains of Methicillin‐Resistant
Staphylococcus aureus in 3 Affiliated Hospitals •
.
Infection Control and Hospital Epidemiology 30:3, 233-241
Online publication date: 1-Mar-2009.
A. M. Strandén, R. Frei, H. Adler, U. Flückiger, A. F. Widmer. (2009) Emergence of SCCmec Type IV as the Most Common Type of Methicillin-Resistant Staphylococcus aureus in a University Hospital.
Infection 37:1, 44-48
Online publication date: 1-Mar-2009.
CrossRef Sun Hee Park, MD; Chulmin Park, PhD; Jin‐Hong Yoo, MD; Su‐Mi Choi, MD; Jung‐Hyun Choi, MD; Hyun‐Ho Shin; Dong‐Gun Lee, MD; Seungok Lee, MD; JaYoung Kim, MD; So Eun Choi, RN, MS; Young‐Mi Kwon, RN, MS; Wan‐Shik Shin, MD. (2009) Emergence of Community‐Associated Methicillin‐Resistant
Staphylococcus aureus Strains as a Cause of Healthcare‐Associated Bloodstream Infections in Korea •
.
Infection Control and Hospital Epidemiology 30:2, 146-155
Online publication date: 1-Feb-2009.
Erica M. C. D’Agata, Glenn F. Webb, Mary Ann Horn, Robert C. Moellering, Jr., and Shigui Ruan. (2009) Modeling the Invasion of Community‐Acquired Methicillin‐Resistant
Staphylococcus aureus into Hospitals.
Clinical Infectious Diseases 48:3, 274-284
Online publication date: 1-Feb-2009.
Mukesh Patel. (2009) Community-Associated Meticillin-Resistant Staphylococcus aureus Infections.
Drugs 69:6, 693-716
Online publication date: 1-Feb-2009.
CrossRef Leonard B. Johnson, MD; Jinson Jose, MD; Farah Yousif, MD; Joan Pawlak, BS; Louis D. Saravolatz, MD. (2009) Prevalence of Colonization With Community‐Associated Methicillin‐Resistant
Staphylococcus aureus Among End‐Stage Renal Disease Patients and Healthcare Workers •
.
Infection Control and Hospital Epidemiology 30:1, 4-8
Online publication date: 1-Jan-2009.
Kyle J. Popovich, MD; Robert A. Weinstein, MD. (2009)
Commentary: The Graying of Methicillin‐Resistant
Staphylococcus aureus •
.
Infection Control and Hospital Epidemiology 30:1, 9-12
Online publication date: 1-Jan-2009.
Kyle J. Popovich, Bala Hota, Robert A. Weinstein. (2008) Treatment of community-associated methicillin-resistant Staphylococcus aureus.
Current Infectious Disease Reports 10:5, 411-420
Online publication date: 1-Oct-2008.
CrossRef Marta Banqué Navarro, Benedikt Huttner, Stephan Harbarth. (2008) Methicillin-resistant Staphylococcus aureus control in the 21st century: beyond the acute care hospital.
Current Opinion in Infectious Diseases 21:4, 372-379
Online publication date: 1-Sep-2008.
CrossRef Farrin A. Manian and Sandy Griesnauer. (2008) Community‐Associated Methicillin‐Resistant
Staphylococcus aureus (MRSA) Is Replacing Traditional Health Care–Associated MRSA Strains in Surgical‐Site Infections among Inpatients.
Clinical Infectious Diseases 47:3, 434-435
Online publication date: 1-Aug-2008.
John M. Boyce. (2008)
Editorial Commentary: Community‐Associated Methicillin‐Resistant
Staphylococcus aureus as a Cause of Health Care–Associated Infection.
Clinical Infectious Diseases 46:6, 795-798
Online publication date: 15-Mar-2008.
