Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T02:04:05.470Z Has data issue: false hasContentIssue false
  • English
  • Français

Differences Between “Classical” Risk Factors for Infections Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) and Risk Factors for Nosocomial Bloodstream Infections Caused by Multiple Clones of the Staphylococcal Cassette Chromosome mec Type IV MRSA Strain

Published online by Cambridge University Press:  02 January 2015

Paula M. Vidal ,
Priscila A. Trindade ,
Tamara O. Garcia ,
Renata L. Pacheco ,
Silvia F. Costa ,
Cristina Reinert ,
Keiichi Hiramatsu ,
Elsa M. Mamizuka ,
Cilmara P. Garcia  and
Anna S. Levin
Paula M. Vidal
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Priscila A. Trindade
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Tamara O. Garcia
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Renata L. Pacheco
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Silvia F. Costa
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Cristina Reinert
Affiliation:
Department of Clinical Analyses, Faculdade de Ciências Farmacêuticas, University of São Paulo, São Paulo, Brazil
Keiichi Hiramatsu
Affiliation:
Department of Bacteriology, Juntendo University, Tokyo, Japan
Elsa M. Mamizuka
Affiliation:
Department of Clinical Analyses, Faculdade de Ciências Farmacêuticas, University of São Paulo, São Paulo, Brazil
Cilmara P. Garcia
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Anna S. Levin*
Affiliation:
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
*
Departments of Infectious Diseases and Hospital Infection Control, Hospital das Clinicas, University of São Paulo, 618 Rua Banibas, 05460-010, São Paulo, SP, Brazil (gcih@hcnet.usp.br)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To identify risk factors associated with nosocomial bloodstream infections caused by multiple clones of the staphylococcal cassette chromosome mec (SCCmec) type IV strain of methicillin-resistant Staphylococcus aureus (MRSA).

Design.

An unmatched case-control study (at a ratio of 1:2) performed during the period from October 2002 through September 2003.

Setting.

A 2,000-bed tertiary care teaching hospital affiliated with the University of São Paulo in São Paulo, Brazil.

Methods.

Case patients (n = 30) were defined either as patients who had a bloodstream infection due to SCCmec type IV MRSA diagnosed at least 48 hours after hospital admission or as neonates with the infection who were born in the hospital. Control patients (n = 60) were defined as patients with SCCmec type III MRSA infection diagnosed at least 48 hours after hospital admission. Genes encoding virulence factors were studied in the isolates recovered from case patients, and molecular typing of the SCCmec type IV MRSA isolates was also done by pulsed-field gel electrophoresis and multilocus sequence typing.

Results.

In multivariate analysis, the following 3 variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: an age of less than 1 year, less frequent use of a central venous catheter (odds ratio [OR], 0.07 [95% confidence interval {CI}, 0.02–0.28]; P = .001), and female sex. A second analysis was performed that excluded the case and control patients from the neonatal unit, and, in multivariate analysis, the following variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: less frequent use of a central venous catheter (OR, 0.12 [95% CI, 0.03–0.55]; P = .007), lower Acute Physiology and Chronic Health Evaluation II score on admission (OR, 0.14 [95% CI, 0.03–.61]; P = .009), less frequent surgery (OR, 0.21 [95% CI, 0.06–0.83]; P = .025), and female sex (OR, 5.70 [95% CI, 1.32–24.66]; P = .020). Of the 29 SCCmec type IV MRSA isolates recovered from case patients, none contained the Panton-Valentine leukocidin, λ-hemolysin, enterotoxin B or C, or toxic shock syndrome toxin-1. All of the isolates contained genes for the LukE-LukD leukocidin and α-hemolysin. Genes for enterotoxin A were present in 1 isolate, and genes for β-hemolysin were present in 3 isolates.

Conclusions.

“Classical” risk factors do not apply to patients infected with the SCCmec type IV strain of MRSA, which is an important cause of nosocomial bacteremia. This strain infects a patient population that is less ill and has had less frequent invasive procedures than a patient population infected with the multidrug-resistant strain of SCCmec type III MRSA. We found that virulence factors were rare and that Panton-Valentine leukocidin was absent. There were multiple clones of the SCCmec type IV strain in our hospital. Children under 1 year of age were at a higher risk. There was a predominant clone (sequence type 5) in this patient population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 2 , February 2009 , pp. 139 - 145
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992–2003. Clin Infect Dis 2006;42:389–391.CrossRefGoogle ScholarPubMed
2.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issue October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
3.Guilarde, AO, Turchi, MD, Martelli, CM, Primo, MG. Staphylococcus aureus bacteraemia: incidence, risk factors and predictors for death in a Brazilian teaching hospital. J Hosp Infect 2006;63:330–336.Google Scholar
4.Fridkin, SK, Hageman, JC, Morrison, M, et al.Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436–1444.CrossRefGoogle ScholarPubMed
5.Ma, XX, Ito, T, Tiensasitorn, C, et al.Novel type of staphylococcal cassette chromosome mec identified in community-acquired methicillin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother 2002;46:1147–1152.CrossRefGoogle ScholarPubMed
6.Ben Nejma, M, Mastouri, M, Frih, S, Sakly, N, Ben Salem, Y, Nour, M. Molecular characterization of methicillin-resistant Staphylococcus aureus isolated in Tunisia. Diagn Microbiol Infect Dis 2006;55:21–26.CrossRefGoogle ScholarPubMed
7.Saiman, L, O'Keefe, M, Graham, PL III, et al.Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003;37:1313–1319.Google Scholar
8.Regev-Yochay, G, Rubinstein, E, Barzilai, A, et al.Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit. Emerg Infect Dis 2005;11:453–456.CrossRefGoogle ScholarPubMed
9.Trindade, PA, Pacheco, RL, Costa, SF, et al.Prevalence of SCCmec type IV in nosocomial bloodstream isolates of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:3435–3437.CrossRefGoogle Scholar
10.Oliveira, DC, de Lencastre, H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2002;46:2155–2161.Google Scholar
11.Knaus, WA, Draper, EA, Wagner, DP, Zimmernab, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
12.Jarraud, S, Mougel, C, Thioulouse, J, et al.Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect Immun 2002;70:631–641.Google Scholar
13.Kuroda, M, Ohta, T, Uchiyama, I, et al.Whole genome sequencing of methicillin-resistant Staphylococcus aureus. Lancet 2001;357:1225–1240.Google Scholar
14.Bannerman, TL, Hancock, GA, Tenover, FC, Miller, JM. Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus. J Clin Microbiol 1995;33:551–555.CrossRefGoogle ScholarPubMed
15.Tenover, F, Arbeit, R, Goering, R, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
16.Enright, MC, Day, NP, Davies, CE, Peacock, SJ, Spratt, BG. Multilocus sequence typing for characterization of methicillin-resistant and meth-icillin-susceptile clones of Stapylococcus aureus. J Clin Microbiol 2000;38:1008–1015.Google Scholar
17.Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus—Minnesota and North Dakota, 1997–1999. JAMA 1999;282:1123–1125.Google Scholar
18.Huang, H, Flynn, NM, King, JH, Monchaud, C, Morita, M, Cohen, SH. Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and hospital-associated MRSA infections in Sacramento, California. J Clin Microbiol 2006;44:2423–2427.CrossRefGoogle ScholarPubMed
19.Donnio, PY, Preney, L, Gautier-Lerestif, AL, Avril, JL, Lafforgue, N. Changes in staphylococcal cassette chromosome type and antibiotic resistance profile in methicillin-resistant Staphylococcus aureus isolates from a French hospital over an 11 year period. J Antimicrob Chemother 2004;53:808–813.CrossRefGoogle ScholarPubMed
20.Davis, SL, Rybak, MJ, Amjad, M, Kaatz, GW, McKinnon, PS. Characteristics of patients with healthcare-associated infection due to SCCmec type IV methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2006;27:1025–1031.CrossRefGoogle ScholarPubMed
21.David, MD, Kearns, AM, Gossain, S, Ganner, M, Holmes, A. Community-associated methicillin-resistant Staphylococcus aureus: nosocomial transmission in a neonatal unit. J Hosp Infect 2006;64:244–250.Google Scholar
22.Gonzalez, BE, Rueda, AM, Shelburne, SA3rd, Musher, DM, Hamill, RJ, Hulten, KG. Community-associated strains of methicillin-resistant Sta-phylococccus aureus as the cause of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27:1051–1056.Google Scholar
23.Klevens, RM, Morrison, MA, Fridkin, SK, et al.Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infect Dis 2006;12:1991–1993.Google Scholar
24.Seybold, U, Kourbatova, EV, Johnson, JG, et al.Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42:647–656.Google Scholar
25.Hardy, KJ, Hawkey, PM, Gao, F, Oppenheim, BA. Methicillin resistant Staphylococcus aureus in the critically ill. Br J Anaesth 2004;92:121–130.CrossRefGoogle ScholarPubMed
26.Wang, FD, Chen, YY, Chen, TL, Liu, CY. Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia. Am J Infect Control 2008;36:118–122.CrossRefGoogle ScholarPubMed
27.Vandenesh, F, Naimi, T, Enright, MC, et al.Community-associated methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003;9:978–984.CrossRefGoogle Scholar
28.Ma, XX, Galiana, A, Pedreira, W, et al.Community-acquired methicillin-resistant Staphylococcus aureus, Uruguay. Emerg Infect Dis 2005;11:973–976.Google Scholar
29.Okuma, K, Iwakawa, K, Turnidge, JD, et al.Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002;40:4289–4294.Google Scholar
30.Morris, JG Jr, Shay, DK, Hebden, JN, et al.Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.CrossRefGoogle Scholar
31.Quale, J, Landman, D, Saurina, G, Atwood, E, DiTore, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.CrossRefGoogle ScholarPubMed