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Journal of Clinical Microbiology, June 2007, p. 1705-1711, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.02311-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Epidemiology and Outcomes of Community-Associated Methicillin-Resistant Staphylococcus aureus Infection{triangledown}

S. L. Davis,1,2 M. B. Perri,1 S. M. Donabedian,1 C. Manierski,1 A. Singh,1 D. Vager,1 N. Z. Haque,1 K. Speirs,4 R. R. Muder,5 B. Robinson-Dunn,4 M. K. Hayden,6 and M. J. Zervos1,3*

Henry Ford Hospital, Detroit, Michigan,1 Eugene Applebaum College of Pharmacy and Health Sciences,2 School of Medicine, Wayne State University, Detroit, Michigan,3 William Beaumont Hospital, Royal Oak, Michigan,4 Pittsburgh Veterans Administration Medical Center, Pittsburgh, Pennsylvania,5 Chicago Rush University, Chicago, Illinois6

Received 14 November 2006/ Returned for modification 20 January 2007/ Accepted 17 March 2007

Over a 2-year period (2003 to 2005) patients with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and community-acquired methicillin-susceptible Staphylococcus aureus (CA-MSSA) infections were prospectively identified. Patients infected with CA-MRSA (n = 102 patients) and CA-MSSA (n = 102 patients) had median ages of 46 and 53 years, respectively; the most common sites of infection in the two groups were skin/soft tissue (80 and 93%, respectively), respiratory tract (13 and 6%, respectively), and blood (4 and 1%, respectively). Fourteen percent of patients with CA-MRSA infections and 3% of patients with CA-MSSA infections had household contacts with similar infections (P < 0.01). Among the CA-MRSA isolates, the pulsed-field gel electrophoresis (PFGE) groups detected were USA300 (49%) and USA100 (13%), with 27 PFGE groups overall; 71% of the isolates were staphylococcal chromosome cassette mec (SCCmec) type IV, 29% were SCCmec type II, and 54% had the Panton-Valentine leucocidin (PVL) gene. Among the CA-MSSA isolates there were 33 PFGE groups, with isolates of the USA200 group comprising 11%, isolates of the USA600 group comprising 11%, isolates of the USA100 group comprising 10%, and isolates of the PVL type comprising 10%. Forty-six and 18% of the patients infected with CA-MRSA and CA-MSSA, respectively, were hospitalized (P < 0.001). Fifty percent of the patients received antibiotic therapy alone, 5% received surgery alone, 30% received antibiotics and surgery, 3% received other therapy, and 12% received no treatment. The median durations of antibiotic therapy were 12 and 10 days in the CA-MRSA- and CA-MSSA-infected patients, respectively; 48 and 56% of the patients in the two groups received adequate antimicrobial therapy, respectively (P < 0.001). The clinical success rates of the initial therapy in the two groups were 61 and 84%, respectively (P < 0.001); recurrences were more common in the CA-MRSA group (recurrences were detected in 18 and 6% of the patients in the two groups, respectively [P < 0.001]). CA-MRSA was an independent predictor of clinical failure in multivariate analysis (odds ratio, 3.4; 95% confidence interval, 1.7 to 6.9). In the community setting, the molecular characteristics of the S. aureus strains were heterogeneous. CA-MRSA infections were associated with a more adverse impact on outcome than CA-MSSA infections.

* Corresponding author. Mailing address: Henry Ford Health System, Wayne State University School of Medicine, Detroit, MI 48202. Phone: (313) 916-2573. Fax: (313) 916-2993. E-mail: mzervos1{at}hfhs.org

{triangledown} Published ahead of print on 28 March 2007.

Journal of Clinical Microbiology, June 2007, p. 1705-1711, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.02311-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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