Epidemiological comparison of true methicillin-resistant and methicillin-susceptible coagulase-negative staphylococcal bacteremia at hospital admission.
We performed 2 case-control studies among 108 patients with true coagulase-negative staphylococcal (CoNS) bacteremia diagnosed within 48 h of hospital admission. Seventy-nine patients (73%) with methicillin-resistant (MR) CoNS bacteremia and 29 patients (27%) with methicillin-susceptible (MS) CoNS bacteremia were compared with 79 randomly selected control patients without CoNS bacteremia. The presence of a central venous catheter was an independent risk factor for both MR- and MS-CoNS bacteremia (P<.001). Patients with MR-CoNS bacteremia were more frequently admitted from health care facilities (P=.02), more likely to have had previous MR Staphylococcus aureus infection or colonization (P=.02), and more likely to have received antibiotics in the previous 30 days (P=.02). The probability that bacteremia was caused by an MR strain, rather than an MS strain, was 62% among patients admitted from the community and 84% among patients admitted from health care facilities. This study identified epidemiological characteristics that can be used to distinguish between MR- and MS-CoNS bacteremia and found high rates of methicillin resistance among CoNS isolates recovered from patients admitted from the community, as well as from health care facilities.
Tacconelli
Evelina
E
Beth Israel Deaconess Medical Center and Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts 02215, USA. etaccone@bidmc.harvard.edu
D'Agata
Erika M C
EM
Karchmer
Adolf W
AW
D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology*; D016022:Case-Control Studies; D003030:Coagulase; D003955:Diagnostic Tests, Routine; D004352:Drug Resistance, Microbial; D004754:Enterobacter / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008712:Methicillin / Q000378:metabolism / Q000627:therapeutic use*; D016106:Methicillin Resistance / Q000502:physiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification
D003030:Coagulase; D008712:Methicillin