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Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia

Published online by Cambridge University Press:  02 January 2015

Leonard B. Johnson ,
Arti Bhan ,
Joan Pawlak ,
Odette Manzor  and
Louis D. Saravolatz
Leonard B. Johnson*
Affiliation:
St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Arti Bhan
Affiliation:
St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Joan Pawlak
Affiliation:
St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Odette Manzor
Affiliation:
St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
Louis D. Saravolatz
Affiliation:
St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan
*
St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI 48236
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Abstract

Objectives:

To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports.

Design:

Retrospective case-comparison study of community-onset MRSA (n - 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution.

Setting:

A 600-bed urban academic medical center.

Patients:

Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001.

Results:

The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases.

Conclusions:

Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 6 , June 2003 , pp. 431 - 435
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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