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Differences between methicillin-resistant Staphylococcus aureus bacteremic isolates harboring type IV and type V staphylococcal cassette chromosome mec genes based on prior patient healthcare exposure

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Abstract

This observational study enrolled adult patients with bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) who were treated at the emergency department of a teaching hospital from 2001 to 2007. MRSA isolates with type IV and type V staphylococcal cassette chromosome mec (SCCmec) genes (SCC IV/V-MRSA) were included in the final analysis. Healthcare-associated SCC IV/V-MRSA (HA-SCC IV/V-MRSA) and community-acquired SCC IV/V-MRSA (CA-SCC IV/V-MRSA) were defined as the identification of an SCC IV/V-MRSA isolate from a patient with and without healthcare-associated risk factors, respectively. Thirty-four cases of CA-SCC IV/V-MRSA (20 SCCmec type IV, 14 SCCmec type V) and 81 cases of HA-SCC IV/V-MRSA (59 SCCmec type IV, 22 SCCmec type V) bacteremia were identified. Vascular device-associated infections were a significant infection source in HA-SCC IV/V-MRSA bacteremia cases. SCCmec type IV HA-SCC IV/V-MRSA isolates (3.4%) were significantly less likely to carry the Panton–Valentine leukocidin (PVL) gene than SCCmec type IV CA-SCC IV/V-MRSA isolates (35.0%, p = 0.001). The 90-day cumulative probability of survival was 76% for patients with CA-SCC IV/V-MRSA bacteremia and 66% for patients with HA-SCC IV/V-MRSA bacteremia (p = 0.247, by the Wilcoxon rank-sum test). Significant differences in antimicrobial susceptibility were observed between bacterial isolates from patients with CA-SCC IV/V-MRSA bacteremia and HA-SCC IV/V-MRSA bacteremia.

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Funding

This study was supported by a grant from the National Science Council in Taiwan (NSC 94-2314-B-002-184).

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Authors and Affiliations

  1. Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China

    S.-Y. Chen, W.-C. Chiang & S.-C. Chen

  2. Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, Republic of China

    J.-L. Wang

  3. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China

    J.-L. Wang, J.-T. Wang & S.-C. Chang

  4. Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China

    T. H.-H. Chen

  5. Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China

    P.-R. Hsueh

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  1. S.-Y. Chen
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  2. J.-L. Wang
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  3. T. H.-H. Chen
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  6. S.-C. Chen
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  8. P.-R. Hsueh
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Correspondence to P.-R. Hsueh.

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Chen, SY., Wang, JL., Chen, T.HH. et al. Differences between methicillin-resistant Staphylococcus aureus bacteremic isolates harboring type IV and type V staphylococcal cassette chromosome mec genes based on prior patient healthcare exposure. Eur J Clin Microbiol Infect Dis 29, 1539–1546 (2010). https://doi.org/10.1007/s10096-010-1038-4

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  • DOI: https://doi.org/10.1007/s10096-010-1038-4

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