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Evolving Epidemiology of Staphylococcus aureus Bacteremia

  • Yoona Rhee (a1) (a2), Alla Aroutcheva (a1) (a2), Bala Hota (a1) (a2), Robert A. Weinstein (a1) (a2) and Kyle J. Popovich (a1) (a2)...

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.


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


Retrospective observational study with molecular analysis.


Large urban public hospital.


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


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.


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.


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

Corresponding author
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 (
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1. SK Fridkin , JC Hageman , M Morrison , et al. Methicillin-resistant Staphylococcus aureus disease in three communities. New Engl J Med 2005;352:14361444.

2. BC Herold , LC Immergluck , MC Maranan , et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.

3. C Liu , CJ Graber , M Karr , 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.

4. KJ Popovich , RA Weinstein , B Hota . Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46:787794.

5. RM Klevens , MA Morrison , J Nadle , et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:17631771.

7. SV Kazakova , JC Hageman , M Matava , et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. New Engl J Med 2005;352:468475.

10. B Hota , C Ellenbogen , MK Hayden , A Aroutcheva , TW Rice , RA Weinstein . 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.

11. KJ Popovich , B Hota , A Aroutcheva , et al. Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients. Clin Infect Dis 2013;56:10671074.

12. NF Crum-Cianflone , AA Burgi , BR Hale . Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus infections among HIV-infected persons. Int J STD AIDS 2007;18:521526.

13. KJ Popovich , RA Weinstein , A Aroutcheva , T Rice , B Hota . Community-associated methicillin-resistant Staphylococcus aureus and HIV: intersecting epidemics. Clin Infect Dis 2010;50:979987.

14. BA Diep , HF Chambers , CJ Graber , 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.

15. NE Lee , MM Taylor , E Bancroft , 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.

16. MZ David , RS Daum , AS Bayer , 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.

18. FC Tenover , LK McDougal , RV Goering , 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.

19. GJ Moran , A Krishnadasan , RJ Gorwitz , et al. Methicillin-resistant S. aureus infections among patients in the emergency department. New Engl J Med 2006;355:666674.

20. U Seybold , EV Kourbatova , JG Johnson , 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.

23. MF Wisniewski , P Kieszkowski , BM Zagorski , WE Trick , M Sommers , RA Weinstein . Development of a clinical data warehouse for hospital infection control. J Am Med Inform Assoc 2003;10:454462.

29. DB Nguyen , FC Lessa , R Belflower , 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.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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