title: Predicting methicillin resistance among community-onset Staphylococcus aureus bacteremia patients with prior healthcare-associated exposure.
abstract: To develop and validate prediction rules to identify the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among community patients who have healthcare-associated (HA) exposure and S. aureus bacteremia. A total of 1,166 adults with community-onset S. aureus bacteremia were retrospectively enrolled. The background prevalence of community MRSA infection was extrapolated from 392 community-associated S. aureus bacteremia (CA-SAB) patients without HA exposure. Complete and clinical risk scores were derived and tested using data from 774 healthcare-associated S. aureus bacteremia (HA-SAB) patients. The risk scores were modeled with and without incorporating previous microbiological data as a model predictor and stratified patients to low-, intermediate-, and high-risk groups for MRSA infection. The clinical risk score included five independent predictors and the complete risk score included six independent predictors. The clinical and complete risk scores stratified 32.7 % and 42.0 % of HA-SAB patients to the low-risk group for MRSA infection respectively. The prevalence of MRSA infection in score-stratified low-risk groups ranged from 16.3 % to 23.3 %, comparable to that of CA-SAB patients (13.8 %). Simple decision rules allow physicians to stratify the risk of MRSA infection when treating community patients with prior HA exposure and possible S. aureus infection.
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xuzhou Road, Zhongzheng District, Taipei 100, Taiwan.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Chen
authors.forename: W-C
authors.initials: WC
authors.lastname: Chiang
authors.forename: M H-M
authors.initials: MH
authors.lastname: Ma
authors.forename: P-R
authors.initials: PR
authors.lastname: Hsueh
authors.forename: S-C
authors.initials: SC
authors.lastname: Chang
authors.forename: C-C
authors.initials: CC
authors.lastname: Fang
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: W-J
authors.initials: WJ
authors.lastname: Chen
authors.forename: W-C
authors.initials: WC
authors.lastname: Chie
authors.forename: M-S
authors.initials: MS
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents