title: Community-onset healthcare-associated MRSA bacteraemia in a district general hospital.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with significant mortality and morbidity. This retrospective study involved 76 episodes over four years in a district general hospital in the UK. Twenty-eight of these episodes (36.8%) occurred within 72 h of admission. All of these, however, had risk factors for MRSA acquisition and were classified as healthcare-associated bacteraemias. The mortality rates (all causes) at seven days and three months were 31.5% and 53.4%, respectively. Ten patients died before targeted therapy could be commenced. All patients in the study had multiple comorbidities, and pneumonia was a common diagnosis. Previous antibiotics, increased age, admission on surgical wards/intensive care units, and the presence of central venous cannulae and urinary catheters were risk factors for infection. In 48.7% of episodes, patients were not known to be colonized with MRSA prior to their bacteraemia. Empirical targeted therapy should be given to patients with risk factors for MRSA and staphylococci in blood cultures pending susceptibility results. Increased use of screening may also be required to reduce transmission and increase the likelihood of appropriate empirical antimicrobial therapy. Eradication of MRSA from carriers in the community should be considered to reduce the number of community-onset healthcare-associated bacteraemias.
authors.affiliation: Department of Infection Control, Hinchingbrooke Hospital, Huntingdon, UK. andreas.karas@papworth.nhs.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Karas
authors.forename: D A
authors.initials: DA
authors.lastname: Enoch
authors.forename: M M
authors.initials: MM
authors.lastname: Emery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D006113:United Kingdom