Comparison of microbiological and clinical characteristics based on SCCmec typing in patients with community-onset meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia.

Molecular identification methods based on the staphylococcal cassette chromosome mec (SCCmec) genotype are more reliable than clinical risk factors and demographic data for differentiating community-acquired and healthcare-associated (HCA) meticillin-resistant Staphylococcus aureus (MRSA). However, patients with community-onset (CO) MRSA infections, defined as a culture-positive sample obtained <48h after admission and from patients with HCA risk factors, have been infrequently studied. This study compared the clinical profiles of different SCCmec genotypes in this group of patients. From 2004 to 2008, the clinical profiles of 122 non-repetitive patients with CO-MRSA infections at a tertiary medical centre in Taiwan were retrospectively recorded and the molecular characteristics of the isolates were examined. The proportion of SCCmec IV/V genotypes increased from 9.5% to 35.3% from 2004 to 2008. There were no differences in demographic data, underlying diseases, invasive procedures or outcomes between the SCCmec II/III and IV/V groups, except that patients with SCCmec II/III genotypes tended to have more HCA risk factors (3.1 vs. 2.4; P=0.008). Multivariate logistic regression analysis revealed that having at least four HCA risk factors was independently associated with SCCmec II/III. The sensitivity of recovering SCCmec IV/V genotypes from patients with less than four HCA risk factors was 89.3%. This study revealed the emergence of SCCmec IV/V genotypes in CO-MRSA infections. Although the clinical characteristic boundaries between SCCmec II/III and IV/V diminished, having at least four HCA risk factors made the presence of SCCmec IV/V genotypes less likely in patients with CO-MRSA infections.

Kuo SC ，Chiang MC ，Lee WS ，Chen LY ，Wu HS ，Yu KW ，Fung CP ，Wang FD ... -  《-》

Emergence of community-associated methicillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated bloodstream infections in Korea.

Park SH ，Park C ，Yoo JH ，Choi SM ，Choi JH ，Shin HH ，Lee DG ，Lee S ，Kim J ，Choi SE ，Kwon YM ，Shin WS ... -  《-》

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

Vidal PM ，Trindade PA ，Garcia TO ，Pacheco RL ，Costa SF ，Reinert C ，Hiramatsu K ，Mamizuka EM ，Garcia CP ，Levin AS ... -  《-》

Comparison between patients under hemodialysis with community-onset bacteremia caused by community-associated and healthcare-associated methicillin-resistant Staphylococcus aureus strains.

Patients receiving hemodialysis infected with methicillin-resistant Staphylococcus aureus (MRSA) have been considered to have healthcare-associated (HA) infections, but strains with community-associated (CA) characteristics have also been identified in this population. The authors compared infections of the two strains among patients with end-stage renal disease. From January 2004 to December 2008 the authors analyzed the demographic and microbiologic data of 57 patients with community-onset (defined as a positive culture obtained ≤ 48 hours after admission) MRSA bacteremia and end-stage renal disease at a 2900-bed tertiary medical center. MRSA isolate with staphylococcal cassette chromosome mec (SCCmec) type II/III was classified as HA strains, and SCCmec type IV/V as CA strains. Forty-seven patients (82%) had HA-MRSA strains and 10 patients (18%) had CA-MRSA strains. The major clones of HA-MRSA were sequence type (ST) 5 with SCCmec type II and staphylococcal protein A (spa) t002 as well as ST239 carrying SCCmec type III and spa t037. The CA-MRSA strains were predominantly ST59, more susceptible to non-β-lactam antimicrobial agents, and had a higher percentage of carrying the Panton-Valentine leukocidin gene in comparision with the HA-MRSA strains. Patients infected with HA-MRSA isolates had a higher overall mortality (57.4%, p = 0.012). In multivariate analysis, male patients were more likely to be infected with HA-MRSA isolates than CA-MRSA strains (p = 0.037), and a history of receiving urinary catheterization within 1 year prior to bacteremia onset (p = 0.047) is an independent risk factor to acquiring HA-MRSA strains. Patients undergoing dialysis and infected with HA-MRSA strains had higher mortality rates and were more commonly associated with urinary catheterization within 1 year before bacteremia.

Wu HS ，Kuo SC ，Chen LY ，Chiang MC ，Lin YT ，Wang FD ，Fung CP ... -  《-》

Clinical and molecular epidemiology of community-acquired, healthcare-associated and nosocomial methicillin-resistant Staphylococus aureus in Spain.

Rodríguez-Baño J ，Angeles Domínguez M ，Blas Millán A ，Borraz C ，Pau González M ，Almirante B ，Cercenado E ，Padilla B ，Pujol M ，GEIH/GEMARA (SEIMC) ，REIPI ... -  《-》