Major Article
Emergence of community-associated methicillin-resistant Staphylococcus aureus USA 300 clone as a cause of health care-associated infections among patients with prosthetic joint infections

https://doi.org/10.1016/j.ajic.2005.06.006Get rights and content

Background

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an important cause of staphylococcal infections, but there have been little data on whether CA-MRSA causes health care-associated infections.

Methods

A case-control study was performed to identify risk factors for prosthetic joint infections (PJI). Antibiograms of isolates associated with PJI were reviewed. Molecular typing of available MRSA isolates was done using pulsed field gel electrophoresis (PFGE). Nares cultures of health care workers who provided care to those orthopedic patients were obtained.

Results

Over a 13-month period (January 2003-January 2004), 9.5% of patients with prosthetic hip (THA) or knee (TKA) joint surgery developed PJI (7 TKA and 2 THA). The mean time to development of PJI was 20 days. Five infections were caused by CA-MRSA and 3 by methicillin-susceptible S aureus; one was culture negative. All CA-MRSA isolates had identical antibiograms (resistant to β-lactams and erythromycin; susceptible to clindamycin, trimethoprim-sulfamethoxazole, rifampin, gentamicin, levofloxacin, and vancomycin). Molecular typing of 2 available CA-MRSA isolates revealed that these were the USA300 clone; these isolates were PVL+ and carried SCCmec IV. CA-MRSA was not recovered from nares cultures from 31 health care workers. In multivariate analysis, TKA (OR, 8.1; 95% CI: 1.3-48.1) and surgery time >180 minutes (OR, 7.4; 95% CI: 1.4-39.6) were associated with PJI.

Conclusion

We have demonstrated that the CA-MRSA USA300 clone is no longer just a cause of community-aquired infections but has also emerged as a cause of health care-associated infections, causing PJI at our institution.

Section snippets

Patient population

All patients who had a total knee (TKA) or total hip (THA) arthroplasty performed at Grady Memorial Hospital (a 1000-bed, public inner-city hospital in Atlanta, GA) between 1 January 2003 and 30 January 2004 were included in the study. The study was approved by the Emory University Institutional Review Board (IRB) and the Grady Research Oversight Committee.

Data collection, cultures, and molecular typing

Medical and laboratory records of patients who had a joint arthroplasty performed during the study period were reviewed, and data were

Patients

Over a 13-month period (January 2003-January 2004), 9 (9.5%) of 95 patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) developed a prosthetic joint infection (7 patients with a TKA infection and 2 with a THA infection) (Fig 1). The mean age of patients was 58 years (range, 28-94 years). The majority of patients was African Americans, 78 (82%), 10 (11%) were white, 4 (4%) were Hispanic, and 3 (3%) were other race; overall, 60% of patients were female. All

Discussion

We have demonstrated the occurrence of health care-associated infections due to the CA-MRSA USA300 clone at our institution. Five of 9 patients with prosthetic joint infections had CA-MRSA isolates recovered from the prosthetic joint within 1 month of surgery. All 5 CA-MRSA isolates had identical antibiograms. The presence of this “community-associated” susceptibility pattern for the MRSA isolates suggested that these health care-associated infections were caused by CA-MRSA. Only 2 of 5 MRSA

References (25)

  • T. Baba et al.

    Genome and virulence determinants of high virulence community-acquired MRSA

    Lancet

    (2002)
  • H.F. Chambers

    The changing epidemiology of Staphylococcus aureus?

    Emerg Infect Dis

    (2001)
  • B.C. Herold et al.

    Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk

    JAMA

    (1998)
  • Centers for Disease Control and Prevention

    Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community

    JAMA

    (2001)
  • Centers for Disease Control and Prevention

    Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections--Los Angeles County, California, 2002-2003

    MMWR Morb Mortal Wkly Rep

    (2003)
  • 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)
  • T.S. Naimi et al.

    Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection

    JAMA

    (2003)
  • King MD, Terrell BJ, Wang YF, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant S. aureus...
  • F. Vandenesch et al.

    Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence

    Emerg Infect Dis

    (2003)
  • L.K. McDougal et al.

    Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database

    J Clin Microbiol

    (2003)
  • L. Saiman et al.

    Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women

    Clin Infect Dis

    (2003)
  • National Committee for Clinical Laboratory Standards

    Performance standards for antimicrobial susceptibility testing. NCCLS approved standard M100-S9

    (1999)
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    Supported by the Emory Mentored Clinical Research Scholars Program (NIH/NCRR K12 RR 017643 to H.M.B. and M.D.K. and NIH/NIAID K23 AI054371-01AI to M.D.K.).

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