Clinical outcomes and treatment approach for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in Israel.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly documented worldwide. We recently identified two major CA-MRSA clones in Israel: USA300 and t991. Here, we assessed clinical outcomes by CA-MRSA clones and the physicians' treatment approach to CA-MRSA infections. All community-onset, clinical MRSA isolates detected during 2011-2013 by Maccabi Healthcare Services were collected and characterized phenotypically and genotypically; data were collected retrospectively from electronic medical records. Of 309 patients with MRSA infections, 64 were identified as CA-MRSA (21 %). Of the CA-MRSA infections, 72 % had skin and soft tissue infections (SSTIs), 38 % were Panton-Valentine leukocidin (PVL)+, the major clone being USA300 (n = 13, 54 %). Of PVL- isolates (n = 40, 62 %), t991 was the major clone. Age was the only predictor for PVL+ CA-MRSA infection (p < 0.001). Patients with PVL+ CA-MRSA had higher incidence of SSTI recurrences (1.061 vs. 0.647 events per patient/per year, p < 0.0001) and were more likely to have the SSTI drained (64 % vs. 21 %, p = 0.003) when compared to PVL- CA-MRSA. USA300 was more common among adults, while t991 was more common among children (p = 0.002). The physician's referral to culture results and susceptibility were the only predictors of appropriate antibiotic therapy (p < 0.001). However, only a minority of physicians referred to culture results, regardless of subspecialties. PVL+ CA-MRSA isolates caused significantly more recurrences of SSTIs and increased the need for drainage compared with PVL- isolates. Physicians' awareness of CA-MRSA as a cause of SSTIs in the community was suboptimal. Culturing of pus-producing SSTIs is crucial for providing adequate antimicrobials and elucidating MRSA epidemiology.
Hebrew University, Jerusalem, Israel.
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E
Berla-Kerzhner
Sheba Medical Center, Ramat Gan, Israel.
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A
Biber
Maccabi Healthcare Services, Rehovot, Israel.
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M
Parizade
Maccabi Healthcare Services, Rehovot, Israel.
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D
Taran
Sheba Medical Center, Ramat Gan, Israel.
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G
Rahav
Sheba Medical Center, Ramat Gan, Israel.|Gertner Institute, Ramat Gan, Israel.
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Regev-Yochay
Pediatric Infectious Diseases Service, Galilee Medical Center, Nahariya, Israel. Danny.Glikman@naharia.health.gov.il.|The Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel. Danny.Glikman@naharia.health.gov.il.
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Glikman
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D005098:Exotoxins / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D058889:Molecular Typing; D010818:Practice Patterns, Physicians'; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
Harefuah. 2009 Nov;148(11):761-5, 794, 793
20027978
JAMA. 1998 Feb 25;279(8):593-8
9486753
J Clin Microbiol. 2015 Aug;53(8):2486-91
26019202
MBio. 2015 Mar 10;6(2):e00054
25759497
Clin Infect Dis. 1999 Nov;29(5):1128-32
10524952
Isr Med Assoc J. 2010 Jul;12(7):428-30
20862825
Lancet. 2006 Mar 4;367(9512):731-9
16517273
Clin Microbiol Infect. 2007 Jul;13(7):725-7
17403127
BMC Infect Dis. 2013 Jul 16;13:325
24060181
Nat Rev Microbiol. 2009 Sep;7(9):629-41
19680247
Eur J Clin Microbiol Infect Dis. 2006 Nov;25(11):719-22
17043835
J Clin Microbiol. 2000 Mar;38(3):1032-5
10698991
J Infect Dis. 2008 May 1;197(9):1235-43
18422435
FEMS Immunol Med Microbiol. 2003 Nov 28;39(2):181-9
14625102
Emerg Infect Dis. 2007 Feb;13(2):236-42
17479885
J Clin Microbiol. 1999 Sep;37(9):2858-62
10449465
J Clin Microbiol. 2010 Oct;48(10):3827-8
20668127
Clin Infect Dis. 2003 Nov 15;37(10):1313-9
14583864
Clin Microbiol Rev. 1997 Jul;10(3):505-20
9227864
Pediatr Infect Dis J. 2009 Nov;28(11):960-5
19738508
PLoS One. 2012;7(8):e42864
22916171
Clin Microbiol Rev. 2010 Jul;23(3):616-87
20610826
J Clin Microbiol. 2010 Feb;48(2):531-8
20007386
J Clin Microbiol. 2013 Mar;51(3):814-9
23269731
Int J Med Microbiol. 2013 Aug;303(6-7):324-30
23517691
J Clin Microbiol. 2006 Jul;44(7):2423-7
16825359
J Clin Microbiol. 1999 Nov;37(11):3556-63
10523551
Emerg Infect Dis. 2002 Sep;8(9):966-70
12194775
J Infect Dis. 2015 Dec 15;212(12 ):1874-82
26048971
Eur J Clin Microbiol Infect Dis. 2015 Aug;34(8):1603-13
25972251