Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA Bacteremia - 07/08/11
, Monica M. Farley a, b, c, Janine L. Ladson c, Sarah Satola a, b, c, Susan M. Ray a, c, d
Corresponding author. Tel.: +1 239 404 2398; fax: +1 404 880 9305.Summary |
Objectives |
To evaluate the association of USA300 genotype with outcomes in persons with MRSA bacteremia and examine the epidemiology of MRSA bacteremia over time.
Methods |
Population-based surveillance for MRSA bacteremia was performed in 8-county Atlanta from 2005 to 2008. Cases of MRSA bacteremia were classified as healthcare-associated hospital-onset (HAHO), healthcare-associated community-onset (HACO), or community-associated (CA) disease. A survival analysis was performed on a nested cohort of cases with isolates characterized by pulse field gel electrophoresis (PFGE).
Results |
4344 MRSA bacteremia cases were identified; 2579 (59.4%) HACO, 1144 (26.3%) HAHO; and 601 (13.8%) CA. Overall incidence rates of MRSA bacteremia declined from 33.9/100,000 in 2005–24.8/100,000 in 2008. Rates were highest in persons ≥ 65 years, blacks, males, and persons with AIDS. In multivariate analysis of 1104 cases, USA300 genotype was associated with increased in-hospital mortality (HR 1.63, 95% CI 1.19–2.23). USA300 strains were also associated with increased mortality when compared to USA100 strains (HR 1.79, 95% CI 1.24–2.58).
Conclusions |
MRSA bacteremia incidence declined over 4 years but CA disease rates remained stable. Persons with HIV, the elderly, and blacks were disproportionately affected. Bacteremia due to USA300 MRSA strains was associated with increased mortality, suggesting that USA300 strains may be more virulent.
Le texte complet de cet article est disponible en PDF.Résumé |
Article Summary |
USA300 genotype is the predominant MRSA strain causing community-associated infections and may be associated with increased virulence. This study demonstrated an association of USA300 strains with increased in-hospital mortality compared with non-USA300 strains, particularly USA100, in persons with MRSA bacteremia.
Le texte complet de cet article est disponible en PDF.Keywords : Methicillin-resistant, Staphylococcus aureus, USA300, Community-associated
Plan
Vol 61 - N° 5
P. 372-381 - novembre 2010 Retour au numéro
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