Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-18T19:57:46.042Z Has data issue: false hasContentIssue false
  • English
  • Français

Characteristics of Patients With Healthcare-Associated Infection Due to SCCmec Type IV Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  29 July 2016

Susan L. Davis ,
Michael J. Rybak ,
Muhammad Amjad ,
Glenn W. Kaatz  and
Peggy S. McKinnon
Susan L. Davis
Affiliation:
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
Michael J. Rybak*
Affiliation:
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
Muhammad Amjad
Affiliation:
Department of Clinical Laboratory Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
Glenn W. Kaatz
Affiliation:
School of Medicine, Wayne State University, Detroit, Michigan
Peggy S. McKinnon
Affiliation:
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan Barnes Jewish Hospital, St. Louis, Missouri
*
Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, (m.rybak@wayne.edu)
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

Methicillin-resistant Staphylococcus aureus (MRSA) with the staphylococcal cassette chromosome mec (SCCmec) type IV allele is most commonly associated with community-acquired MRSA (CA-MRSA) infection; however, such organisms have also been identified in the healthcare setting. The objective of the present study was to characterize the epidemiology of and clinical outcomes associated with SCCmec-IV MRSA infection acquired in the healthcare setting, compared with infection caused by MRSA of other SCCmec types.

Design.

We evaluated a cohort of 100 inpatients with MRSA infection that met the Centers for Disease Control and Prevention definition for healthcare-associated infection and compared the patients' demographic characteristics, the antimicrobial susceptibilities of the MRSA isolates, the infection types, and the associated clinical and microbiological outcomes. For each MRSA isolate, the SCCmec type and the presence of Panton-Valentine leukocidin (PVL) were determined by polymerase chain reaction methods.

Results.

SCCmec-IV MRSA isolates were isolated from 53 patients (42% of these isolates were positive for PVL), and SCCmec-II or SCCmec-III MRSA was isolated from 47 patients (3% of these isolates were positive for PVL). No differences were noted between the patients in the SCCmec-II/III group and the patients in the SCCmec-IV group with respect to age (median, 55 vs 50 years); sex (77% vs 64% of patients were male); medical service (surgical service, 60% in both groups; ICU admission, 55% vs 53%), Acute Physiology and Chronic Health Evaluation II score (median, 8 vs. 7); infection type; or underlying comorbidities, except for presence of a burn wound (13% vs 2%; P < .04). Patients in the SCCmec-II/III group were more likely to have multiple sites of infection (P = .006) and a longer length of stay (LOS) prior to detection of MRSA than were patients in the SCCmec-IV group (median, 4 vs 1 days; P < .001). Total LOS was significantly greater for patients in the SCCmec-II/III, compared with those in the SCCmec-IV group (P = .006). Multiple logistic regression identified liver disease and longer LOS prior to detection of MRSA as predictors of infection with SCCmec-II/III MRSA. Rates of susceptibility to clindamycin, gentamicin, ciprofloxacin, levofloxacin, and tetracycline was significantly greater among SCCmec-IV MRSA isolates, compared with type II/III isolates (P ⩽ .05). Compared with SCCmec-IV isolates acquired in the community, the susceptibility rates among healthcare-associated SCCmec-IV isolates was significantly less for clindamycin, gentamicin, and levofloxacin, indicating that these organisms may quickly acquire resistance to non-β-lactam antibiotics, as do SCCmec-II/III strains.

Conclusions.

SCCmec-IV MRSA appears to have become established in hospitals. The onset of infection caused by SCCmec-IV strains is earlier than the onset of infection with SCCmec-II/III strains; however, associated types of infection are similar. Infection with SCCmec- II/III MRSA is currently associated with an adverse impact on outcome, compared with infection with SCCmec-IV MRSA. Further research is warranted to determine the impact of SCCmec type IV strains in hospital settings.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1025 - 1031
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Barrett, FF, McGehee, RF Jr, Finland, M.. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologic and epidemiologic observations. N Engl J Med 1968; 279:441–448.CrossRefGoogle ScholarPubMed
2. Outbreaks of community-associated methicillin-resistant Staphylococcusaureus skin infections—Los Angeles County, California, 2002-2003. MMWR Morb Mortal Wkly Rep 2003; 52:88.Google Scholar
3. Favero, MS. Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections. Infect Control Hosp Epidemiol 2003; 24:787.Google Scholar
4. File, TM Jr. Community-associated methicillin-resistant Staphylococcusaureus: not only a cause of skin infections, also a new cause of pneumonia. Curr Opin Infect Dis 2005; 18:123–124.CrossRefGoogle Scholar
5. Francis, JS, Doherty, MC, Lopatin, U, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcusaureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis 2005; 40:100–107.CrossRefGoogle Scholar
6. Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcusaureus disease in three communities. N Engl J Med 2005; 352: 1436–1444.CrossRefGoogle Scholar
7. Micek, ST, Dunne, M, Kollef, MH. Pleuropulmonary complications of Panton-Valentine leukocidin-positive community-acquired methicillinresistant Staphylococcus aureus: importance of treatment with antimicrobials inhibiting exotoxin production. Chest 2005; 128:2732–2738.CrossRefGoogle ScholarPubMed
8. Berglund, C, Moiling, P, Sjoberg, L, Soderquist, B. Predominance of staphylococcal cassette chromosome mec (SCCmec) type IV among methiciUinresistant Staphylococcus aureus (MRSA) in a Swedish county and presence of unknown SCCmec types with Panton-Valentine leukocidin genes. Clin Microbiol Infect 2005; 11:447–456.CrossRefGoogle Scholar
9. Fey, PD, Said-Salim, B, Rupp, ME, et al. Comparative molecular analysis of community- or hospital-acquired methiciUin-resistant Staphylococcusaureus. Antimicrob Agents Chemother 2003; 47:196–203.CrossRefGoogle ScholarPubMed
10. Lim, TT, Chong, FN, O'Brien, FG, Grubb, WB. Are all community methiciUin-resistant Staphylococcus aureus related? A comparison of their mec regions. Pathology 2003; 35:336–343.Google Scholar
11. Lina, G, Piemont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29:1128–1132.CrossRefGoogle ScholarPubMed
12. Horan, TC, Gaynes, R. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott Williams & Wilkins; 2004:1659-1702.Google Scholar
13. Robinson, DA, Enright, MC. Evolutionary models of the emergence of methiciUin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2003; 47:3926–3934.Google Scholar
14. Rybak, MJ, Tenover, FC, Amjad, M, Mobarak, R, Kaatz, GW. Identification of community-associated methicillin resistant Staphylococcus aureus (CAMRSA) by clinical and molecular methods in a large urban medical center in Detroit, MI. In: Proceedings of the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington DC. 2004. Washington DC: ASM Press; 2004. Abstract C2-2006.Google Scholar
15. National Committee for Clinical and Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility for Bacteria that Grow Aerobically. 4th ed. Approved standard. NCCLS document, M7-AGoogle Scholar
16. Weisblum, B, Demohn V Erythromycin-inducible resistance in Staphylococcusaureus: survey of antibiotic classes involved. / Bacteriol 1969; 98:447–452.Google Scholar
17. Goering, RV, Winters, MA. Rapid method for epidemiological evaluation of gram-positive cocci by field inversion gel electrophoresis. / Clin Microbiol 1992; 30:577–580.Google Scholar
18. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. / Clin Microbiol 1995; 33:2233–2239.Google Scholar
19. Zhang, K, McClure, J, Elsayer, S, Louie, T, Conly, IM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methiciUin-resistant Staphylococcusaureus. ] Clin Microbiol 2005; 43:5026–5033.Google Scholar
20. Lina, G, Piemont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29:1128–1132.CrossRefGoogle ScholarPubMed
21. Sakoulas, G, Eliopoulos, GM, Moellering, RC Jr, et al. Staphylococcus aureus accessory gene regulator (agr) group II: is there a relationship to the development of intermediate-level glycopeptide resistance? ﹜ Infect Dis 2003; 187:929–938.Google Scholar
22. Hidron, AI, Kourbatova, EV, Halvosa, JS, et al. Risk factors for colonization with methiciUin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 2005; 41:159–166.CrossRefGoogle Scholar
23. O'Brien, FG, Pearman, JW, Gracey, M, Riley, TV, Grubb, WB. Community strain of methiciUin-resistant Staphylococcus aureus involved in a hospital outbreak. / Clin Microbiol 1999; 37:2858–2862.Google Scholar
24. Saiman, L, O'Keefe, M, Graham, PL III, et al. Hospital transmission of community-acquired methiciUin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003; 37:1313–1319.Google Scholar
25. Bratu, S, Eramo, A, Kopec, R, et al. Community-associated methiciUinresistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis 2005; 11:808–813.Google Scholar
26. Healy, CM, Hulten, KG, Palazzi, DL, Campbell, JR, Baker, CJ. Emergence of new strains of methiciUin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004; 39:1460–1466.CrossRefGoogle Scholar
27. Trindade, Pd, Pacheco, RL, Costa, SF, et al. Prevalence of SCCmec type IV in nosocomial bloodstream isolates of methiciUin-resistant Staphylococcusaureus. J Clin Microbiol 2005; 43:3435–3437.CrossRefGoogle Scholar
28. Kaplan, SL, Hulten, KG, Gonzalez, BE, et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005; 40:1785–1791.Google Scholar
29. Miller, LG, Perdreau-Remington, F, Rieg, G, et al. Necrotizing fasciitis caused by community-associated methiciUin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005; 352:1445–1453.Google Scholar
30. Nguyen, DM, Mascola, L, Brancoft, E. Recurring methiciUin-resistant Staphylococcus aureus infections in a football team. Emerg Infect Dis 2005; 11:526–532.Google Scholar
31. Tsuji, BT, Rybak, MJ, Szczesiul, JM, Watt, JL, Amjad, M. Accessory gene regulator (agr) function, group and antimicrobial bactericidal activity in community-acquired methiciUin-resistant Staphylococcus aureus (CAMRSA). In: Program and abstracts of the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington DC, 2005. Washington, DC: ASM Press; 2005. Abstract C2-286.Google Scholar
32. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26:166–174.Google Scholar