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Epidemiology of Methicillin-Resistant Staphylococcus aureus Bloodstream Coinfection Among Adults With Candidemia in Atlanta, GA, 2008–2012

Published online by Cambridge University Press:  27 August 2015

Jessica Reno ,
Saumil Doshi ,
Amy K. Tunali ,
Betsy Stein ,
Monica M. Farley ,
Susan M. Ray  and
Jesse T. Jacob
Jessica Reno
Affiliation:
Atlanta Research and Education Foundation, Decatur, Georgia Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia
Saumil Doshi
Affiliation:
Emory University School of Medicine, Atlanta, Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.]
Amy K. Tunali
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia Emory University School of Medicine, Atlanta, Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.]
Betsy Stein
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia Emory University School of Medicine, Atlanta, Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.]
Monica M. Farley
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia Emory University School of Medicine, Atlanta, Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.]
Susan M. Ray
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Emory University School of Medicine, Atlanta, Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.]
Jesse T. Jacob*
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Emory University School of Medicine, Atlanta, Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.]
*
Address correspondence to Jesse T. Jacob, MD, Orr Building, Ste 1020, 550 Peachtree St NE, Atlanta, GA 30308 ([email protected]).
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Abstract

BACKGROUND

Patients with candidemia are at risk for other invasive infections, such as methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI).

OBJECTIVE

To identify the risk factors for, and outcomes of, BSI in adults with Candida spp. and MRSA at the same time or nearly the same time.

DESIGN

Population-based cohort study.

SETTING

Metropolitan Atlanta, March 1, 2008, through November 30, 2012.

PATIENTS

All residents with Candida spp. or MRSA isolated from blood.

METHODS

The Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.

RESULTS

Among 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%, P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03–2.86]) predicted coinfection.

CONCLUSIONS

A small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.

Infect. Control Hosp. Epidemiol. 2015;36(11):1298–1304

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1298 - 1304
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek 2013; San Francisco, California; October 2013; and Southern Regional Meeting 2013; New Orleans, Louisiana; February 2013.

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