Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection

A prospective investigation

Loren G. Miller, Franciose Perdreau-Remingtom, Arnold S. Bayer, Binh Diep, Nelly Tan, Kiran Bharadwa, Jennifer Tsui, Joshua Perlroth, Anthony Shay, Grace Tagudar, Uzoma Ibebuogu, Brad Spellberg

Research output: Contribution to journalArticle

205 Citations (Scopus)

Abstract

Background. Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach. Methods. We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information. Results. Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60%) had MRSA infection, and 78 (40%) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P < .0001); skin/soft-tissue infection (P = .015); snorting/smoking illegal drugs (P = .01); recent incarceration (P = .03); lower comorbidity index (P = .01); more frequent visits to bars, raves, and/or clubs (P = .03); and higher frequency of laundering clothes in hot water (P = .05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10% (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7% posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous. Conclusions. We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control.

Original languageEnglish (US)
Pages (from-to)471-482
Number of pages12
JournalClinical Infectious Diseases
Volume44
Issue number4
DOIs
StatePublished - Feb 15 2007
Externally publishedYes

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Methicillin
Methicillin-Resistant Staphylococcus aureus
Staphylococcus aureus
Infection
Laundering
Soft Tissue Infections
Clothing
Virulence Factors
Infection Control
Comorbidity
Clone Cells
Smoking
Genotype
Research Personnel
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection : A prospective investigation. / Miller, Loren G.; Perdreau-Remingtom, Franciose; Bayer, Arnold S.; Diep, Binh; Tan, Nelly; Bharadwa, Kiran; Tsui, Jennifer; Perlroth, Joshua; Shay, Anthony; Tagudar, Grace; Ibebuogu, Uzoma; Spellberg, Brad.

In: Clinical Infectious Diseases, Vol. 44, No. 4, 15.02.2007, p. 471-482.

Research output: Contribution to journalArticle

Miller, Loren G. ; Perdreau-Remingtom, Franciose ; Bayer, Arnold S. ; Diep, Binh ; Tan, Nelly ; Bharadwa, Kiran ; Tsui, Jennifer ; Perlroth, Joshua ; Shay, Anthony ; Tagudar, Grace ; Ibebuogu, Uzoma ; Spellberg, Brad. / Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection : A prospective investigation. In: Clinical Infectious Diseases. 2007 ; Vol. 44, No. 4. pp. 471-482.
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abstract = "Background. Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach. Methods. We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information. Results. Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60{\%}) had MRSA infection, and 78 (40{\%}) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P < .0001); skin/soft-tissue infection (P = .015); snorting/smoking illegal drugs (P = .01); recent incarceration (P = .03); lower comorbidity index (P = .01); more frequent visits to bars, raves, and/or clubs (P = .03); and higher frequency of laundering clothes in hot water (P = .05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10{\%} (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7{\%} posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous. Conclusions. We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control.",
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AU - Diep, Binh

AU - Tan, Nelly

AU - Bharadwa, Kiran

AU - Tsui, Jennifer

AU - Perlroth, Joshua

AU - Shay, Anthony

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AU - Ibebuogu, Uzoma

AU - Spellberg, Brad

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N2 - Background. Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach. Methods. We prospectively enrolled consecutive patients who were hospitalized with S. aureus infection, administered a detailed questionnaire, and collected clinical and microbiological information. Results. Of the 280 consenting patients, 180 were adults with CA S. aureus infection. Among these subjects, 108 (60%) had MRSA infection, and 78 (40%) had methicillin-susceptible S. aureus (MSSA) infection. MRSA infection was associated with younger age (P < .0001); skin/soft-tissue infection (P = .015); snorting/smoking illegal drugs (P = .01); recent incarceration (P = .03); lower comorbidity index (P = .01); more frequent visits to bars, raves, and/or clubs (P = .03); and higher frequency of laundering clothes in hot water (P = .05). However, the sensitivity, specificity, and predictive values for these factors for discriminating CA-MRSA infection from CA-MSSA infection were relatively poor. Post-hoc modeling revealed that, even in a 10% (i.e., low) MRSA prevalence population, patients lacking the 3 strongest MRSA risk factors would still have a 7% posttest probability of MRSA. Most MRSA strains belonged to the ST-8/USA300 genotype, contained SCCmec type IV, and shared virulence factors commonly found in the ST1:USA400 clone. MSSA strains were genotypically heterogeneous. Conclusions. We found that clinical and epidemiological risk factors in persons hospitalized for CA S. aureus infection cannot reliably distinguish between MRSA and MSSA. Our findings have important implications for the choice of empirical antibiotic therapy for suspected S. aureus infections and for infection control.

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