title: Impact of prior healthcare-associated exposure on clinical and molecular characterization of methicillin-susceptible Staphylococcus aureus bacteremia: results from a retrospective cohort study.
abstract: By virtue of medical advances and an aging society, people have increased opportunities for healthcare exposure. Little is known about the impact of healthcare exposure on the clinical features and molecular typing of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We classified the onset of MSSA bacteremia into 3 mutually exclusive categories according to the Centers for Disease Control definition, and conducted a retrospective cohort study to investigate the differences among patients with community-associated (CA), healthcare-associated community onset (HACO), and hospital onset (HO) MSSA bacteremia at a medical center from January 1, 2002 through December 31, 2011. Antibiotic susceptibilities and multilocus sequence typing of MSSA isolates were also determined. A total of 290 patients with MSSA bacteremia, including of 165 (56.9%), 91 (31.4%), and 34 (11.7%) of HACO, HO, and CA, respectively, were studied. ST188 (29.3%) was the most common sequence type regardless of classification. Patients with HACO bacteremia were significantly older, had more solid tumors, higher Charlson scores, and more catheter-related bloodstream infections than those with CA bacteremia. The proportions of osteoarticular infections among patients with both HACO and CA bacteremia were higher than that of patients with HO bacteremia. By univariate analysis, patients with HO bacteremia had significantly higher in-hospital mortality compared to those with CA or HACO bacteremia (31.9% vs 18.8% and 20.4%). Multivariate analysis showed that Charlson score (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.10-1.52), septic shock (OR, 5.28; 95% CI, 2.37-11.78), liver cirrhosis (OR, 3.57; 95% CI, 1.14-11.24), receipt of β-lactams other than oxacillin and cefazolin as definitive therapy (OR, 9.27; 95% CI, 4.25-20.23), and higher oxacillin minimum inhibitory concentration (MIC) (≥0.5 mg/L) (OR, 2.35; 95% CI, 1.05-5.25) of the causative pathogen were independently associated with in-hospital mortality. In conclusion, patients with HACO bacteremia had different host factors compared with those with CA bacteremia. Infection foci varied with different onset settings. Overall, ST188 was the most predominant sequence type. Onset settings were not independently associated with outcomes.
authors: From the Department of Internal Medicine, National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan (P-YC); Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (Y-CC, J-TW, S-CC); National Institute of Infectious Diseases and Vaccinology, Miaoli County, Taiwan (J-TW); College of Medicine, National Taiwan University, Taipei, Taiwan (S-CC).
authors: Pao-Yu
authors: PY
authors: Chen
authors: Yu-Chung
authors: YC
authors: Chuang
authors: Jann-Tay
authors: JT
authors: Wang
authors: Shan-Chwen
authors: SC
authors: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology*; D001431:Bacteriological Techniques; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
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