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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, (khulten@bcm.tmc.edu)
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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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