Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus
Background. The majority of research about community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has focused on skin and soft-tissue infections. No literature has been published on the clinical features and outcomes of adult patients with CA-MRSA bacteremia in comparison...
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Veröffentlicht in: | Clinical infectious diseases 2008-03, Vol.46 (6), p.799-806 |
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description | Background. The majority of research about community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has focused on skin and soft-tissue infections. No literature has been published on the clinical features and outcomes of adult patients with CA-MRSA bacteremia in comparison with patients with community-acquired methicillin-susceptible S. aureus (CA-MSSA) bacteremia. Methods. From 1 January 2001 through 31 December 2006, the demographic data and outcome of 215 consecutive adult patients admitted to a tertiary care center in Taiwan with S. aureus bacteremia (age, >16 years) who fulfilled the criteria for community-acquired S. aureus bacteremia were collected for analysis. Results. The mean age (±SD) was 56.8±20.5 years. There were 30 patients (14%) with CA-MRSA bacteremia and 185 (86%) patients with CA-MSSA bacteremia. Cutaneous abscess (odds ratio, 5.46; 95% confidence interval, 1.66–17.94) and necrotizing pneumonia (odds ratio, 24.81; 95% confidence interval, 2.63–234.03) were the independent predictors of CA-MRSA bacteremia; endovascular infection was the only independent predictor of CA-MSSA bacteremia. After Cox regression analysis, the independent significant risk factors for 30-day mortality included increased age, shock, and thrombocytopenia ( |
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The majority of research about community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has focused on skin and soft-tissue infections. No literature has been published on the clinical features and outcomes of adult patients with CA-MRSA bacteremia in comparison with patients with community-acquired methicillin-susceptible S. aureus (CA-MSSA) bacteremia. Methods. From 1 January 2001 through 31 December 2006, the demographic data and outcome of 215 consecutive adult patients admitted to a tertiary care center in Taiwan with S. aureus bacteremia (age, >16 years) who fulfilled the criteria for community-acquired S. aureus bacteremia were collected for analysis. Results. The mean age (±SD) was 56.8±20.5 years. There were 30 patients (14%) with CA-MRSA bacteremia and 185 (86%) patients with CA-MSSA bacteremia. Cutaneous abscess (odds ratio, 5.46; 95% confidence interval, 1.66–17.94) and necrotizing pneumonia (odds ratio, 24.81; 95% confidence interval, 2.63–234.03) were the independent predictors of CA-MRSA bacteremia; endovascular infection was the only independent predictor of CA-MSSA bacteremia. After Cox regression analysis, the independent significant risk factors for 30-day mortality included increased age, shock, and thrombocytopenia (<100,000 cells/µL). After adjustment, the day 30 mortality of patients with CA-MRSA bacteremia was not significantly higher than that of patients with CA-MSSA bacteremia (adjusted hazard ratio, 1.01; 95% confidence interval, 0.30–3.39; P=.986). Most (92%) of 25 available CA-MRSA isolates were multilocus sequence typing 59. Conclusions. The number of adult patients with CA-MRSA bacteremia increased with time, and the disease was associated with more necrotizing pneumonia and cutaneous abscess but less endovascular infection than was CA-MSSA bacteremia. Patients with CA-MRSA bacteremia did not have higher mortality than did patients with CA-MSSA, even though most of the patients with CA-MRSA bacteremia did not receive empirical glycopeptide therapy.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/527389</identifier><identifier>PMID: 18266610</identifier><language>eng</language><publisher>United States: The University of Chicago Press</publisher><subject>Abscesses ; Adult ; Aged ; Anti-Bacterial Agents - pharmacology ; Articles and Commentaries ; Bacteremia ; Bacteremia - microbiology ; Bacteremia - mortality ; Bacteremia - physiopathology ; Bacterial pneumonia ; Community-Acquired Infections - microbiology ; Community-Acquired Infections - mortality ; Community-Acquired Infections - physiopathology ; Comparative analysis ; Endocarditis ; Female ; Health outcomes ; Hospitals, University ; Humans ; Infections ; Male ; Methicillin - pharmacology ; Methicillin Resistance ; Methicillin resistant staphylococcus aureus ; Middle Aged ; Mortality ; Peptides ; Pneumonia ; Prognosis ; Regression analysis ; Risk Factors ; Skin ; Staphylococcal Infections - microbiology ; Staphylococcal Infections - mortality ; Staphylococcus ; Staphylococcus aureus ; Staphylococcus aureus - drug effects ; Staphylococcus aureus - pathogenicity ; Staphylococcus infections ; Taiwan - epidemiology ; Tissues</subject><ispartof>Clinical infectious diseases, 2008-03, Vol.46 (6), p.799-806</ispartof><rights>Copyright 2008 Infectious Diseases Society of America</rights><rights>2008 by the Infectious Diseases Society of America 2008</rights><rights>Copyright University of Chicago, acting through its Press Mar 15, 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c453t-548d5a3b319302c76bb4abd63e7c82780ca1385e21afa48a95e5c75f14e1d4323</citedby><cites>FETCH-LOGICAL-c453t-548d5a3b319302c76bb4abd63e7c82780ca1385e21afa48a95e5c75f14e1d4323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40307099$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40307099$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>315,781,785,804,27929,27930,58022,58255</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18266610$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Jiun-Ling</creatorcontrib><creatorcontrib>Chen, Shey-Ying</creatorcontrib><creatorcontrib>Wang, Jann-Tay</creatorcontrib><creatorcontrib>Wu, Grace Hui-Min</creatorcontrib><creatorcontrib>Chiang, Wen-Chu</creatorcontrib><creatorcontrib>Hsueh, Po-Ren</creatorcontrib><creatorcontrib>Chen, Yee-Chun</creatorcontrib><creatorcontrib>Chang, Shan-Chwen</creatorcontrib><title>Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. The majority of research about community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has focused on skin and soft-tissue infections. No literature has been published on the clinical features and outcomes of adult patients with CA-MRSA bacteremia in comparison with patients with community-acquired methicillin-susceptible S. aureus (CA-MSSA) bacteremia. Methods. From 1 January 2001 through 31 December 2006, the demographic data and outcome of 215 consecutive adult patients admitted to a tertiary care center in Taiwan with S. aureus bacteremia (age, >16 years) who fulfilled the criteria for community-acquired S. aureus bacteremia were collected for analysis. Results. The mean age (±SD) was 56.8±20.5 years. There were 30 patients (14%) with CA-MRSA bacteremia and 185 (86%) patients with CA-MSSA bacteremia. Cutaneous abscess (odds ratio, 5.46; 95% confidence interval, 1.66–17.94) and necrotizing pneumonia (odds ratio, 24.81; 95% confidence interval, 2.63–234.03) were the independent predictors of CA-MRSA bacteremia; endovascular infection was the only independent predictor of CA-MSSA bacteremia. After Cox regression analysis, the independent significant risk factors for 30-day mortality included increased age, shock, and thrombocytopenia (<100,000 cells/µL). After adjustment, the day 30 mortality of patients with CA-MRSA bacteremia was not significantly higher than that of patients with CA-MSSA bacteremia (adjusted hazard ratio, 1.01; 95% confidence interval, 0.30–3.39; P=.986). Most (92%) of 25 available CA-MRSA isolates were multilocus sequence typing 59. Conclusions. The number of adult patients with CA-MRSA bacteremia increased with time, and the disease was associated with more necrotizing pneumonia and cutaneous abscess but less endovascular infection than was CA-MSSA bacteremia. Patients with CA-MRSA bacteremia did not have higher mortality than did patients with CA-MSSA, even though most of the patients with CA-MRSA bacteremia did not receive empirical glycopeptide therapy.</description><subject>Abscesses</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Articles and Commentaries</subject><subject>Bacteremia</subject><subject>Bacteremia - microbiology</subject><subject>Bacteremia - mortality</subject><subject>Bacteremia - physiopathology</subject><subject>Bacterial pneumonia</subject><subject>Community-Acquired Infections - microbiology</subject><subject>Community-Acquired Infections - mortality</subject><subject>Community-Acquired Infections - physiopathology</subject><subject>Comparative analysis</subject><subject>Endocarditis</subject><subject>Female</subject><subject>Health outcomes</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Methicillin - pharmacology</subject><subject>Methicillin Resistance</subject><subject>Methicillin resistant staphylococcus aureus</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Peptides</subject><subject>Pneumonia</subject><subject>Prognosis</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Skin</subject><subject>Staphylococcal Infections - microbiology</subject><subject>Staphylococcal Infections - mortality</subject><subject>Staphylococcus</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus aureus - drug effects</subject><subject>Staphylococcus aureus - pathogenicity</subject><subject>Staphylococcus infections</subject><subject>Taiwan - epidemiology</subject><subject>Tissues</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1DAUhSMEoqXAG4AMC3Ypdhz_ZDkdMQyiI1AHBOrGchxH42kSp_5ROy_Hs-EqUYuQEKt7pfPdc2ydLHuJ4CmCnL4nBcO8epQdI4JZTkmFHqcdEp6XHPOj7Jn3ewgR4pA8zY4QLyilCB5nv5a2H6Uz3g7AtuDMhh1YdmYwSnZgpWWITnsghwZsrAuyM-EALoy_AgvvrTIy6AbcmHR0JlXQTvdGgiZqECxIzn0c0kG-UNfRuERudNgZZboUkF9ob3yQQwDbIMfdobPKKhVTWIqMc-Yf_DZ6pcdg6k6D7elMPc-etLLz-sU8T7Lvqw_fluv8_MvHT8vFea5KgkNOSt4QiWuMKgwLxWhdl7JuKNZM8YJxqCTCnOgCyVaWXFZEE8VIi0qNmhIX-CR7N_mOzl5H7YPoTXpO18lB2-gFgxhhytl_wQJSRmGJE_j2L3BvoxvSJ0SBqooVkFUPbspZ751uxehML91BICjuehdT7wl8PbvFutfNAzYXnYA3E2Dj-G-TVxOz98G6e6qEGDJY3en5pKfe9O29Lt2VoAwzItY_L8Xq64_L9efNVpT4N1MVzbE</recordid><startdate>20080315</startdate><enddate>20080315</enddate><creator>Wang, Jiun-Ling</creator><creator>Chen, Shey-Ying</creator><creator>Wang, Jann-Tay</creator><creator>Wu, Grace Hui-Min</creator><creator>Chiang, Wen-Chu</creator><creator>Hsueh, Po-Ren</creator><creator>Chen, Yee-Chun</creator><creator>Chang, Shan-Chwen</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20080315</creationdate><title>Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus</title><author>Wang, Jiun-Ling ; Chen, Shey-Ying ; Wang, Jann-Tay ; Wu, Grace Hui-Min ; Chiang, Wen-Chu ; Hsueh, Po-Ren ; Chen, Yee-Chun ; Chang, Shan-Chwen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c453t-548d5a3b319302c76bb4abd63e7c82780ca1385e21afa48a95e5c75f14e1d4323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Abscesses</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Articles and Commentaries</topic><topic>Bacteremia</topic><topic>Bacteremia - microbiology</topic><topic>Bacteremia - mortality</topic><topic>Bacteremia - physiopathology</topic><topic>Bacterial pneumonia</topic><topic>Community-Acquired Infections - microbiology</topic><topic>Community-Acquired Infections - mortality</topic><topic>Community-Acquired Infections - physiopathology</topic><topic>Comparative analysis</topic><topic>Endocarditis</topic><topic>Female</topic><topic>Health outcomes</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Infections</topic><topic>Male</topic><topic>Methicillin - pharmacology</topic><topic>Methicillin Resistance</topic><topic>Methicillin resistant staphylococcus aureus</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Peptides</topic><topic>Pneumonia</topic><topic>Prognosis</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Skin</topic><topic>Staphylococcal Infections - microbiology</topic><topic>Staphylococcal Infections - mortality</topic><topic>Staphylococcus</topic><topic>Staphylococcus aureus</topic><topic>Staphylococcus aureus - drug effects</topic><topic>Staphylococcus aureus - pathogenicity</topic><topic>Staphylococcus infections</topic><topic>Taiwan - epidemiology</topic><topic>Tissues</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Jiun-Ling</creatorcontrib><creatorcontrib>Chen, Shey-Ying</creatorcontrib><creatorcontrib>Wang, Jann-Tay</creatorcontrib><creatorcontrib>Wu, Grace Hui-Min</creatorcontrib><creatorcontrib>Chiang, Wen-Chu</creatorcontrib><creatorcontrib>Hsueh, Po-Ren</creatorcontrib><creatorcontrib>Chen, Yee-Chun</creatorcontrib><creatorcontrib>Chang, Shan-Chwen</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Jiun-Ling</au><au>Chen, Shey-Ying</au><au>Wang, Jann-Tay</au><au>Wu, Grace Hui-Min</au><au>Chiang, Wen-Chu</au><au>Hsueh, Po-Ren</au><au>Chen, Yee-Chun</au><au>Chang, Shan-Chwen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2008-03-15</date><risdate>2008</risdate><volume>46</volume><issue>6</issue><spage>799</spage><epage>806</epage><pages>799-806</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Background. The majority of research about community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has focused on skin and soft-tissue infections. No literature has been published on the clinical features and outcomes of adult patients with CA-MRSA bacteremia in comparison with patients with community-acquired methicillin-susceptible S. aureus (CA-MSSA) bacteremia. Methods. From 1 January 2001 through 31 December 2006, the demographic data and outcome of 215 consecutive adult patients admitted to a tertiary care center in Taiwan with S. aureus bacteremia (age, >16 years) who fulfilled the criteria for community-acquired S. aureus bacteremia were collected for analysis. Results. The mean age (±SD) was 56.8±20.5 years. There were 30 patients (14%) with CA-MRSA bacteremia and 185 (86%) patients with CA-MSSA bacteremia. Cutaneous abscess (odds ratio, 5.46; 95% confidence interval, 1.66–17.94) and necrotizing pneumonia (odds ratio, 24.81; 95% confidence interval, 2.63–234.03) were the independent predictors of CA-MRSA bacteremia; endovascular infection was the only independent predictor of CA-MSSA bacteremia. After Cox regression analysis, the independent significant risk factors for 30-day mortality included increased age, shock, and thrombocytopenia (<100,000 cells/µL). After adjustment, the day 30 mortality of patients with CA-MRSA bacteremia was not significantly higher than that of patients with CA-MSSA bacteremia (adjusted hazard ratio, 1.01; 95% confidence interval, 0.30–3.39; P=.986). Most (92%) of 25 available CA-MRSA isolates were multilocus sequence typing 59. Conclusions. The number of adult patients with CA-MRSA bacteremia increased with time, and the disease was associated with more necrotizing pneumonia and cutaneous abscess but less endovascular infection than was CA-MSSA bacteremia. Patients with CA-MRSA bacteremia did not have higher mortality than did patients with CA-MSSA, even though most of the patients with CA-MRSA bacteremia did not receive empirical glycopeptide therapy.</abstract><cop>United States</cop><pub>The University of Chicago Press</pub><pmid>18266610</pmid><doi>10.1086/527389</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Abscesses Adult Aged Anti-Bacterial Agents - pharmacology Articles and Commentaries Bacteremia Bacteremia - microbiology Bacteremia - mortality Bacteremia - physiopathology Bacterial pneumonia Community-Acquired Infections - microbiology Community-Acquired Infections - mortality Community-Acquired Infections - physiopathology Comparative analysis Endocarditis Female Health outcomes Hospitals, University Humans Infections Male Methicillin - pharmacology Methicillin Resistance Methicillin resistant staphylococcus aureus Middle Aged Mortality Peptides Pneumonia Prognosis Regression analysis Risk Factors Skin Staphylococcal Infections - microbiology Staphylococcal Infections - mortality Staphylococcus Staphylococcus aureus Staphylococcus aureus - drug effects Staphylococcus aureus - pathogenicity Staphylococcus infections Taiwan - epidemiology Tissues |
title | Comparison of Both Clinical Features and Mortality Risk Associated with Bacteremia due to Community-Acquired Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus |
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