[Community-onset and nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus in Spanish hospitals].
BACKGROUND
Community-onset infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasing. However, there is little information about community-onset bacteremia (CB) due to MRSA in Spain. The objectives of this study were to evaluate the prevalence, clinical and molecular epidemiology, clinical features, and prognosis of CB due to MRSA in comparison with nosocomial bacteremia (NB).


METHODS
Prospective multicenter cohort study; all new cases of bacteremia due to MRSA occurring during June 2003 in 59 Spanish hospitals were included. Episodes diagnosed during the first 48 hours of admission were considered CB, and otherwise, NB. Isolates were typed by pulsed field electrophoresis and multilocus sequence typing. Staphylococcal cassete chromosome mec types and Panton-Valentine leukocidin genes were studied by polymerase chain reaction.


RESULTS
Sixty-four cases were included; 21 (33%) were classified as CB. In all CB cases, a relation was found with health care, or the isolate proved to be clonally related to nosocomial isolates. There were no significant differences between the groups in terms of demographic data, underlying conditions, prognosis, or characteristics of the isolates. Regarding the source of bacteremia, catheter-related cases were more frequent in NB than CB (39.5% vs 5%, P=0.005), whereas a urinary source was more frequent in CB than NB (25% vs 0%, P=0.001). Most isolates belonged to 2 clones related to the pandemic "pediatric" clone.


CONCLUSIONS
MRSA should be considered in empiric treatment for certain infectious syndromes in patients with healthcare-associated community-onset sepsis.
Millan
Antonio B
AB
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, España.
Domínguez
María Angeles
MA
Borraz
Carmen
C
González
M Pau
MP
Almirante
Benito
B
Cercenado
Emilia
E
Padilla
Belén
B
Pujol
Miquel
M
Rodríguez-Baño
Jesús
J
D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology