title: Meticillin-resistant Staphylococcus aureus blood-stream infection among patients attending the emergency department of an urban tertiary-referral hospital.
abstract: Meticillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen but reports of community-acquired (CA) MRSA are increasing. This study determined the incidence of MRSA-blood-stream infection (BSI) among patients attending the Emergency Department (ED) of an urban tertiary-referral hospital between January 2004 and September 2005, the proportion of cases that were CA or health-care associated (HCA), the epidemiological types of isolates and the presence of pvl genes in CA-MRSA. Eighteen patients presented with MRSA-BSI; 16 cases were categorised as HCA and two as CA. Most patients were male, elderly and lived locally. Two patients (aged <30 years) had no recent previous HC exposure. Only one patient received appropriate empiric antimicrobial therapy. Isolates from patients with HCA-MRSA were similar to the predominant MRSA strain in Irish hospitals. The two CA-MRSA isolates exhibited different epidemiological types; one was pvl-positive. A significant cohort of patients present to the ED with MRSA-BSI. Careful consideration of appropriate empiric antimicrobial therapy for suspected staphylococcal infection is required.
authors.affiliation: Microbiology Department, St. James's Hospital, James's Street, Dublin. boconnell@stjames.ie
authors.forename: B
authors.initials: B
authors.lastname: O'Connell
authors.forename: G
authors.initials: G
authors.lastname: McMahon
authors.forename: M
authors.initials: M
authors.lastname: Kelleher
authors.forename: A S
authors.initials: AS
authors.lastname: Rossney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*