Associations between Staphylococcus aureus Genotype, Infection, and In-Hospital Mortality: A Nested Case-Control Study.
We screened 14,008 adult nonsurgical patients for Staphylococcus aureus nasal carriage at hospital admission and assessed them for invasive S. aureus disease and in-hospital mortality. Multilocus sequence typing was performed on endogenous invasive strains and nasal strains of matched asymptomatic carriers to investigate whether virulent clones could be identified in nasal carriers. Clonal complex (CC) 45 was significantly underrepresented (odds ratio [OR], 0.16 [95% confidence interval {CI}, 0.04-0.59]) and CC30 was overrepresented (not statistically significant) among invasive strains (OR, 1.91 [95% CI, 0.91-4.0]). The distribution of CCs of invasive S. aureus strains in noncarriers did not differ from that in carriers. Those infected with S. aureus strains belonging to a CC had higher mortality than those infected with strains not belonging to a CC (P<.05), which indicates the coevolution of S. aureus virulence and spread in humans.
Wertheim
Heiman F L
HF
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands. h.wertheim@erasmusmc.nl
van Leeuwen
Willem B
WB
Snijders
Susan
S
Vos
Margreet C
MC
Voss
Andreas
A
Vandenbroucke-Grauls
Christina M J E
CM
Kluytmans
Jan A J W
JA
Verbrugh
Henri A
HA
van Belkum
Alex
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D005260:Female; D005838:Genotype; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality*; D013211:Staphylococcus aureus / Q000145:classification* / Q000235:genetics*; D014774:Virulence
D001426:Bacterial Proteins