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Journal of Clinical Microbiology, May 2009, p. 1443-1451, Vol. 47, No. 5
0095-1137/09/$08.00+0     doi:10.1128/JCM.01197-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

High Levels of mecA DNA Detected by a Quantitative Real-Time PCR Assay Are Associated with Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia {triangledown}

Ya-Chi Ho,1,2 Shan-Chwen Chang,2 Su-Ru Lin,3 and Wei-Kung Wang2,3*

Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch,1 Department of Internal Medicine, National Taiwan University Hospital,2 Institute of Microbiology, College of Medicine, National Taiwan University, Taipei, Taiwan3

Received 25 June 2008/ Returned for modification 2 October 2008/ Accepted 2 March 2009

Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is known to be a poor prognostic factor. While several PCR assays for the detection of MRSA in various clinical samples were recently reported, the possibility that a quantitative PCR assay could be used to quantify and monitor MRSA bacteremia has not been explored. In this study, we established a quantitative real-time PCR assay for the mecA gene using known copy numbers of a plasmid containing mecA DNA as a standard and the previously described mecA-specific primers and probe (P. Francois et al., J. Clin. Microbiol. 41:254-260, 2003). We employed this assay to examine 250 sequential whole-blood samples from 20 adult patients, including 13 survivors and 7 nonsurvivors, with culture-proven MRSA bacteremia at the intensive care units of National Taiwan University Hospital between 1 July 2006 and 31 January 2007. The levels of mecA DNA in the nonsurvivors were significantly higher than those in the survivors during the three periods of bacteremia examined (days 0 to 2, 3 to 5, and 6 to 8) (P = 0.003 by two-tailed Mann-Whitney U test). Moreover, the nonsurvivors had higher mecA DNA levels than the survivors after 3 days and 7 days of anti-MRSA therapy (medians for nonsurvivors and survivors at 3 days, 5.86 and 4.30 log copies/ml, respectively; medians for nonsurvivors and survivors at 7 days, 5.21 and 4.36 log copies/ml, respectively; P = 0.02 and P = 0.04, respectively, by two-tailed Mann-Whitney U test). Together, these findings suggest that the level of mecA DNA in blood could potentially be used to monitor MRSA bacteremia and evaluate responses to therapy.

* Corresponding author. Present address: Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, BSB 320, 651 Ilalo Street, Honolulu, HI 96813. Phone: (808) 692-1667. Fax: (808) 692-1984. E-mail: wwang60{at}yahoo.com

{triangledown} Published ahead of print on 11 March 2009.

Journal of Clinical Microbiology, May 2009, p. 1443-1451, Vol. 47, No. 5
0095-1137/09/$08.00+0     doi:10.1128/JCM.01197-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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