Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-08T02:19:40.822Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors Associated with Methicillin Resistance among Staphylococcus aureus Infections in Veterans

Published online by Cambridge University Press:  02 January 2015

Natalie L. McCarthy ,
Patrick S. Sullivan ,
Robert Gaynes  and
David Rimland
Patrick S. Sullivan
Affiliation:
Rollins School of Public Health, Atlanta, Georgia
Robert Gaynes
Affiliation:
School of Medicine, Atlanta, Georgia Emory University, and the Veterans Affairs Medical Center, Atlanta, Georgia
David Rimland*
Affiliation:
School of Medicine, Atlanta, Georgia Emory University, and the Veterans Affairs Medical Center, Atlanta, Georgia
*
Medical Specialty Service Line (111-RIM), Veterans Affairs Medical Center, 1670 Clairmont Road, Decatur, GA 30033 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging concern in infectious disease practice. Although MRSA infections occur in a wide variety of anatomic sites, the majority of studies considering the risk factors for methicillin resistance among S. aureus infections have focused on MRSA bacteremia.

Objective.

To describe risk factors associated with methicillin resistance among S. aureus infections at different anatomic sites.

Methods.

We collected information on the demographic and clinical characteristics of patients examined at the Atlanta Veterans Affairs Medical Center with S. aureus infections during the period from June 2007 through May 2008. We used multivariate logistic regression to describe factors significantly associated with methicillin resistance.

Results.

There were 568 cases of S. aureus infection among 528 patients. We identified 352 cases (62%) of MRSA infection and 216 cases (38%) of methicillin-sensitive S. aureus infection. The adjusted odds of methicillin resistance were higher among infections that occurred among patients who had a prior history of MRSA infection (odds ratio [OR], 3.9 [95% confidence interval {CI}, 2.3–6.4]) or resided in a long-term care facility during the past 12 months (OR, 2.0 [95% CI, 1.0-4.0]) but were lower for infections that occurred among patients who had undergone a biopsy procedure during the past 12 months (OR, 0.7 [95% CI, 0.6-0.9]). Most cases of infection were community-onset infections (523 [92%] of 568 cases), and about one-half (278 [49%]) were not healthcare associated.

Conclusions.

Compared with previous studies of methicillin resistance among patients with S. aureus bacteremia, we found similar factors to be associated with methicillin resistance among S. aureus isolates recovered from more diverse anatomic sites of infection. Of note, nearly one-half of our cases of MRSA infection were not healthcare associated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 36 - 41
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
2.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-suceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.Google Scholar
3.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:2229–2235.CrossRefGoogle ScholarPubMed
4.Shurland, S, Zhan, M, Bradham, DD, Roghmnn, M. Comparison of mortality risk associated with bacteremia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28:273–279.CrossRefGoogle ScholarPubMed
5.Wang, J, Chen, S, Wang, J, et al. Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus. Clin Infect Dis 2008;46:799–806.CrossRefGoogle ScholarPubMed
6.Gonzalez, C, Rubio, M, Romero-Vivas, J, Gonzalez, M, Picazo, JJ. Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 1999;29:1171–1177.CrossRefGoogle ScholarPubMed
7.Laupland, KB, Ross, T, Gregson, DB. Staphylococcus aureus bloodstream infections: risk factors, outcomes, and the influence of methicillin resistance in Calgary, Canada, 2000-2006. J Infect Dis 2008;198:336–343.CrossRefGoogle ScholarPubMed
8.Sadoyama, G, Gontijo Filho, PP. Risk factors for methicillin resistant and sensitive Staphylococcus aureus infection in a Brazilian university hospital. Braz J Infect Dis 2000;4:135–143.Google Scholar
9.Munckhof, WJ, Nimmo, GR, Carney, J, et al. Methicillin-susceptible, non-multiresistant methicillin-resistant and multiresistant methicillin-resistant Staphylococcus aureus infections: a clinical, epidemiological and microbiological comparative study. Eur J Clin Microbiol Infect Dis 2008;27:355–364.Google Scholar
10.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
11.Klevens, RM, Morrison, MA, Fridkin, SK, et al. Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infect Dis 2006;12:1991–1993.CrossRefGoogle ScholarPubMed
12.Cockcroft, DW, Gault, MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.CrossRefGoogle ScholarPubMed
13.Kleinbaum, DG, Klein, M. Logistic Regression: A Self-Learning Text. 2nd ed. New York, NY: Springer; 2002.Google Scholar
14.Jorgensen, JH. Laboratory and epidemiologic experience with methicillin-resistant Staphylococcus aureus in the United States. Eur J Clin Microbiol 1986;5:693–696.CrossRefGoogle Scholar
15.Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(Suppl 3B):221S–227S.Google Scholar
16.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1995;98:599–600.Google Scholar
17.Haley, CC, Mittal, D, La Violette, A, Jannapureddy, S, Parvez, N, Haley, RW. Methicillin-resistant Staphylococcus aureus infection of colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing. J Clin Microbiol 2007;45:3031–3038.Google Scholar
18.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–674.Google Scholar
19.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection of colonization. Clin Infect Dis 2003;36:281–285.CrossRefGoogle ScholarPubMed
20.Beam, JW, Buckley, B. Community-acquired methicillin-resistant Staphylococcus aureus: prevalence and risk factors. J AM Train 2006;41:337–340.Google ScholarPubMed
21.Bradley, S, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle ScholarPubMed
22.Bakowski, E, Wey, SB, Medeiros, EAS. Risk factors for bacteremia and predictors of mortality of patients with bloodstream infection with methicillin-resistant Staphylococcus aureus. Am J Infect Dis 2008;4:174–178.Google Scholar
23.Wang, F, Chen, Y, Chen, T, Liu, C. Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia. Am J Infect Control 2008;36:118–122.CrossRefGoogle ScholarPubMed
24.Chi, C, Wong, W, Fung, C, Yu, K, Liu, C. Epidemiology of community-acquired Staphylococcus aureus bacteremia. J Microbiol Immunol Infect 2004;37:16–23.Google Scholar
25.Lowy, FD, Aiello, AE, Bha, M, et al. Staphylococcus aureus colonization and infection in New York state prisons. J Infect Dis 2007;196:911–918.CrossRefGoogle ScholarPubMed
26.Vanden, F, Naimi, T, Enright, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003;9:978–984.Google Scholar
27.Miller, LG, Perdreau-Remington, F, Bayer, AS, et al. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis 2007;44:471–482.Google Scholar
28.Crum, NF, Lee, RU, Thornton, SA, et al. Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med 2006;119:943–951.Google Scholar
29.Diederen, BMW, Kluytmans, JAJW. The emergence of infections with community-associated methicillin resistant Staphylococcus aureus. J Infect 2006;52:157–168.CrossRefGoogle ScholarPubMed
30.Rollason, J, Bastin, L, Hilton, AC, et al. Epidemiology of community-acquired methicillin-resistant Staphylococcus aureus obtained from the UK West Midlands region. J Hosp Infect 2008;70:314–320.CrossRefGoogle ScholarPubMed
31.Muto, C, Jerigan, J, Ostrowsky, B, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.Google Scholar