JAC Advance Access published online on February 4, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh107
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Division of Infectious
Diseases, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, USA
* Corresponding author. E-mail: etaccone{at}bidmc.harvard.edu.
Received 29 July 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
Methicillin-resistant Staphylococcus
aureus bacteraemia diagnosed at hospital admission: distinguishing
between community-acquired versus healthcare-associated strains
2 Department
of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, USA
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