title: Epidemiology and clonality of methicillin-resistant and methicillin-susceptible Staphylococcus aureus causing bacteremia in a tertiary-care hospital in Spain.
abstract: OBJECTIVE
  To describe the relative proportions of nosocomial and community-onset Staphylococcus aureus bacteremia at our institution and the epidemiologic characteristics and clonal diversity of S. aureus isolates, as determined by pulsed-field gel electrophoresis (PFGE) and antimicrobial resistance patterns.
  
  
  METHODS
  Retrospective cohort study of all cases of S. aureus bacteremia between October 2001 and October 2002.
  
  
  METHODS
  A 1300-bed, tertiary-care hospital.
  
  
  RESULTS
  One hundred sixty-two unique episodes of S. aureus bacteremia were identified. Forty-three cases (26.5%) were caused by methicillin-resistant S. aureus (MRSA). Most cases of S. aureus bacteremia, whether MRSA or methicillin susceptible (MSSA), were nosocomial in origin (77.2%) or were otherwise associated with the healthcare system (16%). Only 11 (6.8%) of the cases (all MSSA) were strictly community acquired. Thirty-five unique macrorestriction patterns were identified among the 154 isolates that were typed by PFGE. Four major genotypes were defined among the isolates of MRSA, with 36 (85.7%) represented by a single PFGE type. Of the isolates within this major clone, all (100%) were ciprofloxacin resistant and 77.8% were erythromycin resistant. In contrast, the 112 isolates of MSSA comprised 31 different PFGE types, 3 of which represented 42.9% of all MSSA isolates and were associated with both nosocomial and community-onset bacteremia.
  
  
  CONCLUSIONS
  Most cases of S. aureus bacteremia in our healthcare region are nosocomial in origin or are acquired through contact with the healthcare system and are thus potentially preventable. To preclude dissemination of pathogenic clones, it is therefore necessary to redouble preventive measures in both the hospital and the community.
authors.affiliation: The authors are from Servicio de Microbiología, Hospital Universitario Doce de Octubre, Madrid, Spain. fchaves.hdoc@salud.madrid.org
authors.forename: Fernando
authors.initials: F
authors.lastname: Chaves
authors.forename: Jesus
authors.initials: J
authors.lastname: García-Martínez
authors.forename: Sonia
authors.initials: S
authors.lastname: de Miguel
authors.forename: Francisca
authors.initials: F
authors.lastname: Sanz
authors.forename: Joaquín R
authors.initials: JR
authors.lastname: Otero
mesh_terms: D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000635:transmission; D013211:Staphylococcus aureus / Q000302:isolation & purification