title: Epidemiology of bloodstream infections caused by methicillin-resistant Staphylococcus aureus at a tertiary care hospital in New York.
abstract: BACKGROUND
  In the United States, bloodstream infections (BSIs) are predominated by Staphylococcus aureus. The proportion of community-acquired methicillin-resistant S aureus (MRSA) BSI is on the rise. The goal of this study is to explore the epidemiology of BSI caused by S aureus within Staten Island, New York.
  
  
  METHODS
  This is a case-case-control study from April 2012-October 2014. Cases were comprised of patients with BSI secondary to MRSA and methicillin-sensitive S aureus (MSSA). The control group contained patients who were hospitalized during the same time period as cases but did not develop infections during their stay. Two multivariable models compared each group of cases with the uninfected controls.
  
  
  RESULTS
  A total of 354 patients were analyzed. Infections were community acquired in 76% of cases. The major source of BSI was skin-related infections (n = 76). The first multivariable model showed that recent central venous catheter placement was an independent infection risk factor (odds ratio [OR] = 80.7; 95% confidence interval [CI], 2.2-3,014.1). In the second model, prior hospital stay >3 days (OR = 4.1; 95% CI, 1.5-5.7) and chronic kidney disease (OR = 3.0; 95% CI, 1.01-9.2) were uniquely associated with MSSA. Persistent bacteremia, recurrence, and other hospital-acquired infections were more likely with MRSA BSI than MSSA BSI.
  
  
  CONCLUSIONS
  Most infections were community acquired. The presence of a central venous catheter constituted a robust independent risk factor for MRSA BSI. Patients with MRSA BSI suffered worse outcomes than those with MSSA BSI.
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY. Electronic address: myasmin@schoolph.umass.edu.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Yasmin
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY.
authors.forename: Halim
authors.initials: H
authors.lastname: El Hage
authors.affiliation: The Graduate Center, City University of New York, New York, NY.
authors.forename: Rita
authors.initials: R
authors.lastname: Obeid
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY.
authors.forename: Hanine
authors.initials: H
authors.lastname: El Haddad
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY.
authors.forename: Mazen
authors.initials: M
authors.lastname: Zaarour
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY.
authors.forename: Ambreen
authors.initials: A
authors.lastname: Khalil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D017714:Community-Acquired Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D063128:Tertiary Health Care; D055815:Young Adult
keywords: Antibiotic resistance; MRSA; Methicillin-resistant Staphylococcus aureus; New York; Risk factors; Staphylococcus