medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2010, Number 6

<< Back Next >>

Rev Invest Clin 2010; 62 (6)

Epidemiology and clinical characteristics of Staphylococcus aureus bloodstream infections in a tertiary-care center in Mexico City: 2003-2007

Ponce-de-León A, Camacho-Ortiz A, Macías AE, Landín-Larios C, Villanueva-Walbey C, Trinidad-Guerrero D, López-Jácome E, Galindo-Fraga A, Bobadilla-del-Valle M, Sifuentes-Osornio J

Language: English
References: 30
Page: 553-559
PDF size: 67.70 Kb.


ABSTRACT

Objective. To compare the epidemiology, clinical variables, outcome and molecular characteristics between methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bloodstream infections (BSI) of patients from a tertiary-care center. Methods. We conducted a five-year retrospective cohort analysis of all patients with at least one peripherally-drawn blood culture positive for S. aureus. Patient characteristics, clinical data and outcome were analyzed, as well as microbiologic data. Results. We included 444 isolates derived from 172 patients. The highest rate of MRSA BSI was observed in 2005 (4.9 cases per 1,000 patients). MRSA BSIs were more likely to be originated from a skin and soft tissue infection (OR 2.44, CI 95% 1.05-5.67, p = 0.03). The only significant risk factor for MRSA BSI was the mean length of hospital stay (OR 1.01; CI 95% 1.00-1.02, p = 0.002). A difference in inadequate initial treatment was noticed in MRSA BSI (OR 8.35 CI 95% 1.55-8.39, p = 0.002); but it had no impact on mortality. All MRSA isolates were SCCmec type II, and we did not find any resistance to vancomycin or linezolid. Conclusion. MRSA BSIs were associated with a prolonged hospital stay. We did not observe any difference in mortality between MRSA and MSSA BSIs. During the study period, we only identified SCCmec type II in MRSA isolates, which suggests that this infection was hospital- acquired.


REFERENCES

  1. Tomic V, Svetina Sorli P, Trinkaus D, Sorli J, Widmer AF, Trampuz A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004; 164: 2038-43.

  2. Harbarth S, Rutschmann O, Sudre P, Pittet D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998; 158: 182-9.

  3. Tverdek FP, Crank CW, Segreti J. Antibiotic therapy of methicillin-resistant Staphylococcus aureus in critical care. Crit Care Clin 2008; 24: 249-60.

  4. 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: 943-51.

  5. Romero-Vivas J, Rubio M, Fernandez C, Picazo JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995; 21: 1417-23.

  6. Wallin TR, Hern HG, Frazee BW. Community-associated methicillin-resistant Staphylococcus aureus. Emerg Med Clin N Am 2008; 26: 431-55.

  7. 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: 309-32.

  8. Maree CL, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 2007; 13: 236-42.

  9. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; sixteenth informational supplement. 2006; 26(3): 118-23, table 2c.

  10. Louie L, Goodfellow J, Mathieu P, Glatt A, Louie M, Simor AE. Rapid detection of methicillin-resistant Staphylococci from blood culture bottles by using a multiplex PCR assay. J Clin Microbiol 2002; 40: 2786-90.

  11. Zhang K, McClure JA, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005; 43: 5026-33.

  12. Sifuentes-Osornio J, Guerrero-Almeida MC, Ponce de León- Garduño LA, Guerrero-Almeida ML. Trends for bacteremia and risk factors for death in a tertiary hospital in Mexico City. 1981-1992. Gac Med Mex 2001; 137: 191-202.

  13. Kato-Maeda M, Bautista-Alavez A, Rolón-Montes-de-Oca AL,et al. Increasing trend of antimicrobial drug-resistance in organisms causing bacteremia at a tertiary-care hospital: 1995 to 2000. Rev Invest Clin 2003; 55: 600-05.

  14. Kluytmans J, Struelens M. Meticillin resistant Staphylococcus aureus in the hospital. BMJ 2009; 338: b364.

  15. Khatib R, Schaffer C, Johnson LB. Staphylococcus aureus in a single positive blood culture: causes and outcome. Scand J Infect Dis 2002; 34: 645-7.

  16. Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26: 166-74.

  17. Cosgrove SE, Fowler VG. Management of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2008; 46: S386-S393.

  18. Fowler VG Jr, Boucher HW, Corey GR, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med 2006; 355: 653-65.

  19. Wang JL, Chen SY, Wang JT. 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.

  20. Abrams B, Sklaver A, Hoffman T, Greenman R. Single or combination therapy of staphylococcal endocarditis in intravenous drug abusers. Ann Intern Med 1979; 90: 789-91.

  21. González C, Rubio M, Romero-Vivas J, González 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: 1171-7.

  22. Wyllie DH, Crook DW, Peto TE. Mortality after Staphylococcus aureus bacteremia in two hospitals in Oxfordshire, 1997- 2003: cohort study. BMJ doi:10.1136/bmj.38834.421713.2F (published 23 June 2006).

  23. Francis JF, Doherty MC, Lopatin, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant staphylococcus aureus carrying the panton-valentine leukocidin genes. Clin Infect Dis 2005; 40: 100-07.

  24. Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med 2007; 357: 380-90.

  25. Diep BA, Sensabaugh GF, Somboona NS, Carleton HA, Perdreau- Remington F. Widespread skin and soft-tissue infections due to two methicillin-resistant Staphylococcus aureus strains harboring the genes for Panton-Valentine leucocidin. J ClinMicrobiol 2004; 42: 2080-4.

  26. Rubinstein E, Kollef MH, Nathwani D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2008; 46(Suppl 5): S378-S385.

  27. O’Brien FG, Pearman JW, Gracey M, Riley TV, Grubb WB. Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 1999; 37: 2858-62.

  28. Borer A, Gilad J, Yagupsky P. et al. Community-acquired methicillin-resistant Staphylococcus aureus in institutionalized adults with developmental disabilities. Emerg Infect Dis 2002; 8: 966-70.

  29. Echániz-Aviles G, Velázquez-Meza ME, Aires-de-Sousa M. et al. Molecular characterization of a dominant methicillin- resistant Staphylococcus aureus (MRSA) clone in a Mexican hospital (1999-2003). Clin Microbiol Infect 2006; 12: 22-8.

  30. Velazquez-Meza ME, Aires de Sousa M, Echaniz-Aviles G. et al. Surveillance of methicillin-resistant Staphylococcus aureus in a pediatric hospital in Mexico City during a 7-year period (1997 to 2003): clonal evolution and impact of infection control. J Clin Microbiol 2004; 42: 3877-80.




2020     |     www.medigraphic.com