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Evolving Epidemiology of Staphylococcus aureus Bacteremia

Published online by Cambridge University Press:  16 September 2015

Yoona Rhee
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Alla Aroutcheva
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Bala Hota
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Kyle J. Popovich*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
*
Address correspondence to Kyle J. Popovich, MD, MS, Rush University Medical Center, Division of Infectious Diseases, 600 S Paulina St, Ste 143, Chicago, IL 60612 (kyle_popovich@rush.edu).

Abstract

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) infections due to USA300 have become widespread in community and healthcare settings. It is unclear whether risk factors for bloodstream infections (BSIs) differ by strain type.

OBJECTIVE

To examine the epidemiology of S. aureus BSIs, including USA300 and non-USA300 MRSA strains.

DESIGN

Retrospective observational study with molecular analysis.

SETTING

Large urban public hospital.

PATIENTS

Individuals with S. aureus BSIs from January 1, 2007 through December 31, 2013.

METHODS

We used electronic surveillance data to identify cases of S. aureus BSI. Available MRSA isolates were analyzed by pulsed-field gel electrophoresis. Poisson regression was used to evaluate changes in BSI incidence over time. Risk factor data were collected by medical chart review and logistic regression was used for multivariate analysis of risk factors.

RESULTS

A total of 1,015 cases of S. aureus BSIs were identified during the study period; 36% were due to MRSA. The incidence of hospital-onset (HO) MRSA BSIs decreased while that of community-onset (CO) MRSA BSIs remained stable. The rate of CO– and HO– methicillin-susceptible S. aureus infections both decreased over time. More than half of HO-MRSA BSIs were due to the USA300 strain type and for 4 years, the proportion of HO-MRSA BSIs due to USA300 exceeded 60%. On multivariate analysis, current or former drug use was the only epidemiologic risk factor for CO- or HO-MRSA BSIs due to USA300 strains.

CONCLUSIONS

USA300 MRSA is endemic in communities and hospitals and certain populations (eg, those who use illicit drugs) may benefit from enhanced prevention efforts in the community.

Infect. Control Hosp. Epidemiol. 2015;36(12):1417–1422

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. New Engl J Med 2005;352:14361444.CrossRefGoogle ScholarPubMed
2. Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.CrossRefGoogle ScholarPubMed
3. Liu, C, Graber, CJ, Karr, M, et al. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-2005. Clin Infect Dis 2008;46:16371646.CrossRefGoogle Scholar
4. Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46:787794.CrossRefGoogle ScholarPubMed
5. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:17631771.CrossRefGoogle ScholarPubMed
6. Begier, EM, Frenette, K, Barrett, NL, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39:14461453.CrossRefGoogle ScholarPubMed
7. Kazakova, SV, Hageman, JC, Matava, M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. New Engl J Med 2005;352:468475.CrossRefGoogle ScholarPubMed
8. Campbell, KM, Vaughn, AF, Russell, KL, et al. Risk factors for community-associated methicillin-resistant Staphylococcus aureus infections in an outbreak of disease among military trainees in San Diego, California, in 2002. J Clin Microbiol 2004;42:40504053.CrossRefGoogle Scholar
9. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus infections in correctional facilities—Georgia, California, and Texas, 2001-2003. MMWR Morb Mortal Wkly Rep 2003;52:992996.Google Scholar
10. Hota, B, Ellenbogen, C, Hayden, MK, Aroutcheva, A, Rice, TW, Weinstein, RA. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med 2007;167:10261033.CrossRefGoogle Scholar
11. Popovich, KJ, Hota, B, Aroutcheva, A, et al. Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients. Clin Infect Dis 2013;56:10671074.CrossRefGoogle ScholarPubMed
12. Crum-Cianflone, NF, Burgi, AA, Hale, BR. Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus infections among HIV-infected persons. Int J STD AIDS 2007;18:521526.CrossRefGoogle ScholarPubMed
13. Popovich, KJ, Weinstein, RA, Aroutcheva, A, Rice, T, Hota, B. Community-associated methicillin-resistant Staphylococcus aureus and HIV: intersecting epidemics. Clin Infect Dis 2010;50:979987.CrossRefGoogle ScholarPubMed
14. Diep, BA, Chambers, HF, Graber, CJ, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Int Med 2008;148:249257.CrossRefGoogle ScholarPubMed
15. Lee, NE, Taylor, MM, Bancroft, E, et al. Risk factors for community-associated methicillin-resistant Staphylococcus aureus skin infections among HIV-positive men who have sex with men. Clin Infect Dis 2005;40:15291534.CrossRefGoogle ScholarPubMed
16. David, MZ, Daum, RS, Bayer, AS, et al. Staphylococcus aureus bacteremia at 5 US academic medical centers, 2008-2011: significant geographic variation in community-onset infections. Clin Infect Dis 2014;59:798807.CrossRefGoogle ScholarPubMed
17. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Int Med 2013;173:19701978.Google Scholar
18. Tenover, FC, McDougal, LK, Goering, RV, et al. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol 2006;44:108118.CrossRefGoogle ScholarPubMed
19. Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. New Engl J Med 2006;355:666674.CrossRefGoogle ScholarPubMed
20. Seybold, U, Kourbatova, EV, Johnson, JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care–associated bloodstream infections. Clin Infect Dis 2006;42:647656.CrossRefGoogle Scholar
21. Diekema, DJ, Richter, SS, Heilmann, KP, et al. Continued emergence of USA300 methicillin-resistant Staphylococcus aureus in the United States: results from a nationwide surveillance study. Infect Control Hosp Epidemiol 2014;35:285292.CrossRefGoogle ScholarPubMed
22. Popovich, KJ, Weinstein, RA. Commentary: the graying of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2009;30:912.CrossRefGoogle ScholarPubMed
23. Wisniewski, MF, Kieszkowski, P, Zagorski, BM, Trick, WE, Sommers, M, Weinstein, RA. Development of a clinical data warehouse for hospital infection control. J Am Med Inform Assoc 2003;10:454462.CrossRefGoogle ScholarPubMed
24. McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:51135120.CrossRefGoogle ScholarPubMed
25. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. New Engl J Med 2013;368:22552265.CrossRefGoogle ScholarPubMed
26. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24:362386.CrossRefGoogle ScholarPubMed
27. Patel, G, Jenkins, SG, Mediavilla, JR, et al. Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus among patients in an ambulatory hemodialysis center. Infect Control Hosp Epidemiol 2011;32:881888.CrossRefGoogle Scholar
28. Centers for Disease Control and Prevention. Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients—United States, 2005. MMWR Morb Mortal Wkly Rep 2007;56:197199.Google Scholar
29. Nguyen, DB, Lessa, FC, Belflower, R, et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011. Clin Infect Dis 2013;57:13931400.CrossRefGoogle ScholarPubMed