title: Epidemiology and staphylococcal cassette chromosome mec typing of methicillin-resistant Staphylococcus aureus isolates in Taiwan: A multicenter study.
abstract: OBJECTIVE
  After community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was identified, new community-onset, healthcare-associated MRSA (HA-MRSA-CO) infections have been noticed as MRSA infection in patients with community-onset infection who have underlying conditions resulting in frequent exposure to the healthcare system. However, previous studies have not thoroughly investigated whether HA-MRSA-CO has characteristics resembling those of CA-MRSA or hospital-onset, healthcare-associated MRSA (HA-MRSA-HO) infection.
  
  
  METHODS
  A multicenter, retrospective study was conducted to analyze the clinical and microbiological data of patients with clinical isolates of MRSA from nine hospitals in Taiwan.
  
  
  RESULTS
  In total, 203 patients with MRSA isolates, including 27 patients with CA-MRSA (13.3%), 59 with HA-MRSA-CO (29.1%), and 117 with HA-MRSA-HO (57.6%), were studied. Compared to HA-MRSA-HO isolates, the CA-MRSA and HA-MRSA-CO isolates were associated with a higher proportion of skin and soft tissue infections (81.8% and 65.3% vs. 40.5%, p=0.001 and p=0.002) as well as lesser rate of resistance to ciprofloxacin (33.3% and 50.9% vs. 74.4%, p<0.001 and p=0.002), gentamicin (44.4% and 64.4% vs. 84.6%, p<0.001 and p=0.002), and trimethoprim/sulfamethoxazole (33.3% and 42.4% vs. 58.1%, p=0.02 and p=0.048), and a lower 30-day all-cause mortality rate (7.4% and 0% vs. 20.9%, p<0.001). Most of the CA-MRSA isolates were classified as staphylococcal cassette chromosome mec (SCCmec) type VT (11/27, 40.7%), whereas most HA-MRSA-HO isolates were classified as SCCmec type III (66/117, 56.4%).
  
  
  CONCLUSIONS
  The CA-MRSA, HA-MRSA-CO, and HA-MRSA-HO clinical isolates significantly differed in their clinical presentations and molecular characteristics.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Sung-Ching
authors: SC
authors: Pan
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Jann-Tay
authors: JT
authors: Wang
authors: Department of Clinical Research, National Health Research Institute, Taipei, Taiwan.
authors: Tsai-Ling
authors: TL
authors: Lauderdale
authors: Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan.
authors: Wen-Chien
authors: WC
authors: Ko
authors: Department of Internal Medicine, Veterans General Hospital, Kaohsiung, Taiwan.
authors: Yao-Shen
authors: YS
authors: Chen
authors: Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors: Jien-Wei
authors: JW
authors: Liu
authors: Department of Internal Medicine, Show-Chwan Memorial Hospital, Chung-Hua, Taiwan.
authors: Yeu-Jun
authors: YJ
authors: Lau
authors: Department of Internal Medicine, Buddhist Tzu-Chi Hospital, Hualien, Taiwan.
authors: Li-Hsin
authors: LH
authors: Wang
authors: Department of Internal Medicine, Chung Shan Medical College Hospital, Taichung, Taiwan.
authors: Ke-Sun
authors: KS
authors: Liu
authors: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.
authors: Chun-Hsing
authors: CH
authors: Liao
authors: Department of Internal Medicine, St. Mary's Hospital, Lo-Tung, Taiwan.
authors: San-Yi
authors: SY
authors: Lin
authors: Department of Internal Medicine, Taipei City Hospital, Heping Branch, Taipei, Taiwan.
authors: Bor-Shen
authors: BS
authors: Hu
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: changsc@ntu.edu.tw.
authors: Shan-Chwen
authors: SC
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002876:Chromosomes, Bacterial; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: methicillin resistance; staphylococcal infections