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Staphylococcus aureus Bacteremia at 5 US Academic Medical Centers, 2008-2011: Significant Geographic Variation in Community-Onset Infections

2014; Oxford University Press; Volume: 59; Issue: 6 Linguagem: Inglês

10.1093/cid/ciu410

1537-6591

Michael David, Robert S. Daum, Arnold S. Bayer, Henry F. Chambers, Vance G. Fowler, Loren G. Miller, Belinda Ostrowsky, A. Baesa, Susan Boyle‐Vavra, Samantha J. Eells, Sylvia Garcia‐Houchins, P. Gialanella, Raul Macias Gil, Thomas H. Rude, Felicia Ruffin, Julia Sieth, J. Volinski, Brad Spellberg,

Streptococcal Infections and Treatments

Examining 4171 bacteremia episodes in 2008–2011, community-onset methicillin-resistant Staphylococcus aureus (MRSA) rates differed dramatically at 5 US academic medical centers. USA300 accounted for 52% of genotyped MRSA isolates, varying by center from 35% to 80%. Background. The incidence of community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) bacteremia rose from the late 1990s through the 2000s. However, hospital-onset (HO) MRSA rates have recently declined in the United States and Europe. Methods. Data were abstracted from infection prevention databases between 1 January 2008 and 31 December 2011 at 5 US academic medical centers to determine the number of single-patient blood cultures positive for MRSA and methicillin-susceptible S. aureus (MSSA) per calendar year, stratified into CO and HO infections. Results. Across the 5 centers, 4171 episodes of bacteremia were identified. Center A (Los Angeles, California) experienced a significant decline in CO-MRSA bacteremia rates (from a peak in 2009 of 0.42 to 0.18 per 1000 patient-days in 2011 [P = .005]), whereas CO-MSSA rates remained stable. Centers B (San Francisco, California), D (Chicago, Illinois), and E (Raleigh-Durham, North Carolina) experienced a stable incidence of CO-MRSA and CO-MSSA bacteremia. In contrast, at center C (New York, New York), the incidence of CO-MRSA increased >3-fold (from 0.11 to 0.34 cases per 1000 patient-days [P < .001]). At most of the sites, HO-MRSA decreased and HO-MSSA rates were stable. USA300 accounted for 52% (104/202) of genotyped MRSA isolates overall, but this varied by center, ranging from 35% to 80%. Conclusions. CO-MRSA rates and the contribution of USA300 MRSA varied dramatically across diverse geographical areas in the United States. Enhanced infection control efforts are unlikely to account for such variation in CO infection rates. Bioecological and clinical explanations for geographical differences in CO-MRSA bacteremia rates merit further study.