Bone and joint infection as a predictor of community-acquired methicillin-resistant Staphylococcus aureus bacteraemia: a comparative cohort study.
BACKGROUND
A new clone of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), sequence type (ST) 72-staphylococcal chromosomal cassette mec (SCCmec) type IV/IVA without the Panton-Valentine leucocidin (PVL) genes, has been the major clonal type in Korea since 2007. However, there have been no evaluations of the clinical features, risk factors and outcomes associated with CA-MRSA bacteraemia in Korea.


METHODS
Adult patients with community-acquired S. aureus bacteraemia (SAB) were enrolled between 1 January 2004 and 31 September 2012. We compared the clinical features and outcomes of CA-MRSA bacteraemia with those of community-acquired methicillin-susceptible S. aureus (CA-MSSA) bacteraemia and evaluated the risk factors for CA-MRSA infection. A microbiological study of the CA-MRSA isolates was also conducted.


RESULTS
In total, 169 patients were included, i.e. 31 (18%) patients with CA-MRSA bacteraemia and 138 (82%) patients with CA-MSSA bacteraemia. Bone and joint infection [45.2% (14/31) versus 22.5% (31/138); adjusted OR, 2.61; 95% CI, 1.09-6.21] was an independent predictor of CA-MRSA bacteraemia. There were no significant differences in relapse of bacteraemia and mortality within 12 weeks after SAB between the two groups. ST72-SCCmec type IV/IVA without the PVL genes was the most common genotype, especially among bone and joint infections (64%, 9/14) as well as among the CA-MRSA isolates (71%, 22/31).


CONCLUSIONS
CA-MRSA accounted for 18% of community-acquired SAB and was significantly associated with bone and joint infection. Our study suggests that CA-MRSA should be considered in patients with bone and joint infection and that empirical therapy against MRSA should be included.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Ju Young
JY
Lee
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Center for Antimicrobial Resistance and Microbial Genetics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Yong Pil
YP
Chong
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Tark
T
Kim
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Hyo-Lim
HL
Hong
Center for Antimicrobial Resistance and Microbial Genetics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Su-Jin
SJ
Park
Center for Antimicrobial Resistance and Microbial Genetics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eun-Sook
ES
Lee
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Mi-Na
MN
Kim
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sung-Han
SH
Kim
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang-Oh
SO
Lee
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang-Ho
SH
Choi
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jun Hee
JH
Woo
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Center for Antimicrobial Resistance and Microbial Genetics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea yskim@amc.seoul.kr.
Yang Soo
YS
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult
SCCmec; methicillin susceptible; sequence type