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 Mar 15;46(6):799-806. doi: 10.1086/527389.

Abstract

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 56.8+/-20.5 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/microL). 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; P = .986). 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents* / pharmacology
  • Bacteremia* / microbiology
  • Bacteremia* / mortality
  • Bacteremia* / physiopathology
  • Community-Acquired Infections* / microbiology
  • Community-Acquired Infections* / mortality
  • Community-Acquired Infections* / physiopathology
  • Female
  • Hospitals, University
  • Humans
  • Male
  • Methicillin / pharmacology*
  • Methicillin Resistance*
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Staphylococcal Infections* / microbiology
  • Staphylococcal Infections* / mortality
  • Staphylococcus aureus* / drug effects
  • Staphylococcus aureus* / pathogenicity
  • Taiwan / epidemiology

Substances

  • Anti-Bacterial Agents
  • Methicillin