JAC Advance Access originally published online on February 4, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 474-479
© 2004 The British Society for Antimicrobial Chemotherapy
Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains
1 Division of Infectious Diseases and 2 Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Received 29 July 2003; returned 19 October 2003; revised 23 November 2003; accepted 11 December 2003
Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections diagnosed at hospital admission are often referred to as community-acquired. This designation may include MRSA strains previously acquired in a healthcare setting (healthcare-associated) as well as those that have emerged from community-based S. aureus strains.
Methods: To understand further the epidemiology of MRSA from the community, a case-control study was performed. During 1997–2002, 254 patients with and without MRSA bacteraemia at hospital admission were studied.
Results: All patients with MRSA bacteraemia in the first 24 h of hospital admission had a recent exposure to a healthcare setting: true community-acquired MRSA was not detected. Independent risk factors for healthcare-associated MRSA bacteraemia, defined as MRSA bacteraemia in the first 24 h of hospital admission among patients with a recent exposure to a healthcare setting or intervention, included previous MRSA infection or colonization (OR = 17, P < 0.001), cellulitis (OR = 4, P = 0.006), presence of a central venous catheter (OR = 3, P < 0.001) and skin ulcers (OR = 3, P = 0.007).
Conclusions: In this study, MRSA bacteraemia diagnosed in the first 24 h of hospital admission represented healthcare-associated MRSA strains and not true community-acquired strains. The clinical characteristics associated with healthcare-associated MRSA bacteraemia can assist clinicians in targeting measures to prevent cross-transmission and may help to streamline empirical vancomycin therapy.
Keywords: S. aureus, methicillin resistance, risk factors
* Corresponding author. Beth Israel Deaconess Medical Center, Harvard Medical School, Division Infectious Diseases, Kennedy-6, 330 Brookline Ave., Boston, MA 02215, USA. Tel: +1-617-667-8127; Fax: +1-617-632-0766; E-mail: etaccone{at}bidmc.harvard.edu
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