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Community-Associated Strains of Methicillin-Resistant Staphylococccus aureus as the Cause of Healthcare-Associated Infection

Published online by Cambridge University Press:  21 June 2016

Blanca E. Gonzalez ,
Adriana M. Rueda ,
Samuel A. Shelburne III ,
Daniel M. Musher ,
Richard J. Hamill  and
Kristina G. Hultén
Blanca E. Gonzalez
Affiliation:
Departments of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
Adriana M. Rueda
Affiliation:
Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Samuel A. Shelburne III
Affiliation:
Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
Daniel M. Musher
Affiliation:
Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Richard J. Hamill
Affiliation:
Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Kristina G. Hultén*
Affiliation:
Departments of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
*
Texas Children's Hospital, Mail Code 3-2371, 6621 Fannin Street, Houston, TX 77030, ([email protected])
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Extract

Objective:

Methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients with community-associated infection have been described as strains genetically distinct from the strains isolated from patients with healthcare-associated infection. This study examines the hypothesis that community-associated MRSA (CA-MRSA) strains now cause serious infections in hospitalized patients.

Methods.

Thirty-seven clinical MRSA isolates were randomly selected from blood isolates obtained from July 2003 through June 2004. Strains were tested for staphylococcal chromosomal cassette mec (SCCmec) type, pulsed-field gel electrophoresis (PFGE) type, and presence of Panton-Valentine leukocidin (PVL) genes. Medical records review and epidemiologic classification was performed by an investigator blinded to the results of the bacterial strain analysis. Episodes of bloodstream infection were independently classified as either community-associated or healthcare-associated infections, and bacterial isolates were independently classified as either CA-MRSA strains or healthcare-associated MRSA (HA-MRSA) strains, according to established definitions.

Setting.

A tertiary care Veterans Affairs Medical Center.

Results.

Twenty-four (65%) of 37 MRSA isolates were SCCmec type IV, a genetic type characteristic of CA-MRSA strains; 22 of these 24 isolates belonged to the CA-MRSA clone USA300 and carried PVL genes. Thirteen (35%) of the 37 strains were SCCmec type II, of which 12 were USA100-ST5 and 12 lacked PVL genes. Thirty patients (81%) had healthcare-associated infections; 18 (60%) of these 30 were infected with isolates carrying markers of CA-MRSA strains. Of 7 patients with CA-MRSA infections, 6 were infected with isolates belonging to the USA300 clone. Patients with healthcare-associated bloodstream infections were as likely to be infected with a CA-MRSA strain as patients with a community-associated infection (P = .38).

Conclusions.

MRSA strains with molecular characteristics of CA-MRSA strains have emerged as an important cause of serious health-care-associated infection in our hospital.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1051 - 1056
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. Boyce, JM, Causey, WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control 1982; 3:377–383.Google Scholar
2. Boyce, JM, White, RL, Spruill, EY. Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections. J Infect Dis 1983; 148:763.Google Scholar
3. Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279:593–598.CrossRefGoogle ScholarPubMed
4. Naimi, TS, LeDell, KH, Boxrud, DJ, et al. Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota, 1996-1998. Clin Infect Dis 2001; 33:990–996.Google Scholar
5. Said-Salim, B, Mathema, B, Kreiswirth, BN. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen. Infect Control Hosp Epidemiol 2003; 24:451–455.Google Scholar
6. Sattler, CA, Mason, EO Jr, Kaplan, SL. Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children. Pediatr Infect Dis J 2002; 21:910–917.Google Scholar
7. Francis, JS, Doherty, MC, Lopatin, U, 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; 40:100–107.Google Scholar
8. Gonzalez, BE, Martinez-Aguilar, G, Hulten, KG, et al. Severe staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus . Pediatrics 2005; 115:642–648.Google Scholar
9. Miller, LG, Perdreau-Remington, F, Rieg, G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005; 352:1445–1453.Google Scholar
10. Mongkolrattanothai, K, Boyle, S, Kahana, MD, Daum, RS. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. Clin Infect Dis 2003; 37:1050–1058.CrossRefGoogle ScholarPubMed
11. Buckingham, SC, McDougal, LK, Cathey, LD, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee Children's Hospital. Pediatr Infect Dis J 2004; 23:619–624.Google Scholar
12. Kazakova, SV, Hageman, JC, Matava, M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005; 352:468–475.Google Scholar
13. Mishaan, AM, Mason, EO Jr, Martinez-Aguilar, G, et al. Emergence of a predominant clone of community-acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J 2005; 24:201–206.Google Scholar
14. Fey, PD, Said-Salim, B, Rupp, ME, et al. Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 2003; 47:196–203.Google Scholar
15. Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of community-and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976–8294.Google Scholar
16. Charlebois, ED, Perdreau-Remington, F, Kreiswirth, B, et al. Origins of community strains of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2004; 39:47–54.CrossRefGoogle ScholarPubMed
17. Dufour, P, Gillet, Y, Bes, M, et al. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis 2002; 35:819–824.CrossRefGoogle ScholarPubMed
18. Vandenesch, F, Naimi, T, Enright, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003; 9:978–984.Google Scholar
19. Daum, RS, Ito, T, Hiramatsu, K, et al. A novel methicillin-resistance cassette in community-acquired methicillin-resistant Staphylococcus aureus isolates of diverse genetic backgrounds. J Infect Dis 2002; 186:1344–1347.CrossRefGoogle ScholarPubMed
20. Ito, T, Ma, XX, Takeuchi, F, Okuma, K, Yuzawa, H, Hiramatsu, K. Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC. Antimicrob Agents Chemother 2004; 48:2637–2651.Google Scholar
21. Ito, T, Okuma, K, Ma, XX, Yuzawa, H, Hiramatsu, K. Insights on antibiotic resistance of Staphylococcus aureus from its whole genome: genomic island SCC. Drug Resist Updat 2003; 6:41–52.Google Scholar
22. Baba, T, Takeuchi, F, Kuroda, M, et al. Genome and virulence determinants of high virulence community-acquired MRSA. Lancet 2002; 359:1819–1827.Google Scholar
23. Deresinski, S. Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic Odyssey. Clin Infect Dis 2005; 40:562–573.Google Scholar
24. Shelburne, SA, Musher, DM, Hulten, K, et al. In vitro killing of community-associated methicillin-resistant Staphylococcus aureus with drug combinations. Antimicrob Agents Chemother 2004; 48:4016–4019.Google Scholar
25. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137:791–797.CrossRefGoogle ScholarPubMed
26. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.CrossRefGoogle ScholarPubMed
27. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial disk susceptibility testing, 15th informational supplement. Wayne, PA; CLSI, 2005.Google Scholar
28. Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbiol 1990; 28:2059–2063.Google Scholar
29. Hulten, KG, Kaplan, SL, Gonzalez, BE, et al. Three-year surveillance of community onset health care-associated Staphylococcus aureus infections in children. Pediatr Infect Dis J 2006; 25:349–353.CrossRefGoogle ScholarPubMed
30. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33:2233–2239.Google Scholar
31. Multi Locus Sequence Typing (MLST) Web site. Available at: http://www.mlst.net/. Accessed August 30, 2006.Google Scholar
32. 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; 41:5113–5120.Google Scholar
33. Levy, MM, Fink, MP, Marshall, JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–1256.Google Scholar
34. Methicillin-resistant Staphylococcus aureus infections among competitive sports participants—Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR Morb Mortal Wkly Rep 2003; 52:793–795.Google Scholar
35. Nguyen, DM, Mascola, L, Brancoft, E. Recurring methicillin-resistant Staphylococcus aureus infections in a football team. Emerg Infect Dis 2005; 11:526–532.CrossRefGoogle Scholar