title: Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA bacteremia.
abstract: OBJECTIVE
  To evaluate the association of USA300 genotype with outcomes in persons with MRSA bacteremia and examine the epidemiology of MRSA bacteremia over time.
  
  
  METHODS
  Population-based surveillance for MRSA bacteremia was performed in 8-county Atlanta from 2005 to 2008. Cases of MRSA bacteremia were classified as healthcare-associated hospital-onset (HAHO), healthcare-associated community-onset (HACO), or community-associated (CA) disease. A survival analysis was performed on a nested cohort of cases with isolates characterized by pulse field gel electrophoresis (PFGE).
  
  
  RESULTS
  4344 MRSA bacteremia cases were identified; 2579 (59.4%) HACO, 1144 (26.3%) HAHO; and 601 (13.8%) CA. Overall incidence rates of MRSA bacteremia declined from 33.9/100,000 in 2005-24.8/100,000 in 2008. Rates were highest in persons ≥ 65 years, blacks, males, and persons with AIDS. In multivariate analysis of 1104 cases, USA300 genotype was associated with increased in-hospital mortality (HR 1.63, 95% CI 1.19-2.23). USA300 strains were also associated with increased mortality when compared to USA100 strains (HR 1.79, 95% CI 1.24-2.58).
  
  
  CONCLUSIONS
  MRSA bacteremia incidence declined over 4 years but CA disease rates remained stable. Persons with HIV, the elderly, and blacks were disproportionately affected. Bacteremia due to USA300 MRSA strains was associated with increased mortality, suggesting that USA300 strains may be more virulent.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Dr. Atlanta, GA 30303, USA. rkempke@emory.edu
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.forename: Janine L
authors.initials: JL
authors.lastname: Ladson
authors.forename: Sarah
authors.initials: S
authors.lastname: Satola
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics*; D008875:Middle Aged; D012307:Risk Factors; D018571:Sentinel Surveillance; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D016019:Survival Analysis; D055815:Young Adult