Clinical and epidemiological factors associated with methicillin resistance in community-onset invasive Staphylococcus aureus infections: prospective multicenter cross-sectional study in Korea

Abstract

Successful empirical therapy of Staphylococcus aureus infections requires the ability to predict methicillin resistance. Our aim was to identify predictors of methicillin resistance in community-onset (CO) invasive S. aureus infections. Sixteen hospitals across Korea participated in this study from May to December 2012. We prospectively included cases of S. aureus infection in which S. aureus was isolated from sterile clinical specimens ≤ 72 hours after hospitalization. Clinical and epidemiological data were gathered and compared in methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) cases. Community-associated (CA) infections were defined as in previous studies. In total, there were 786 cases of community-onset S. aureus infection, 102 (13.0%) of which were CA-MRSA. In addition to known risk factors, exposure to 3rd generation cephalosporins in the past 6 months [odds ratio (OR), 1.922; 95% confidence interval (CI), 1.176-3.142] and close contact with chronically ill patients in the past month (OR, 2.647; 95% CI, 1.189-5.891) were independent risk factors for MRSA infection. However, no clinical predictors of CA-MRSA were identified. Methicillin resistance, CO infection, and appropriateness of empirical antibiotics were not significantly related to 30-day mortality. MRSA infection should be suspected in patients recently exposed to 3rd generation cephalosporins or chronically-ill patients. There were no reliable predictors of CA-MRSA infection, and mortality was not affected by methicillin resistance.

Figure 1. Schematic diagram describing the classification of Staphylococcus aureus infections as community-associated (CA) or healthcare-associated (HA) according to methicillin-resistance (MRSA) or methicillin susceptibility (MSSA).

Figure 2. Antibiotic susceptibility profiles of the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates and the healthcare-associated MRSA (HA-MRSA) isolates.

ERY, CLI, CIP, RIF, SUL, GEN, TET, VAN, and TEI denote erythromycin, clindamycin, ciprofloxacin, rifampin, sulfamethoxazole-trimethoprim, gentamicin, tetracycline, vancomycin, and teicoplanin, respectively. Data for CIP, RIF, SUL, GEN, TET, and TEI were missing for 2, 1, 34, 4, 2, and 1 patient(s), respectively. * and ** indicate statistical significance at P<0.05 and 0.01, respectively (χ2 test).