國家衛生研究院 NHRI:Item 3990099045/6360

NHRI > National Institute of Infectious Diseases and Vaccinology > Shu-Chen Kuo > Periodical Articles > Item 3990099045/6360

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Title:	Comparison between patients under hemodialysis with community-onset bacteremia caused by community-associated and healthcare-associated methicillin-resistant Staphylococcus aureus strains
Authors:	Wu, HS;Kuo, SC;Chen, LY;Chiang, MC;Lin, YT;Wang, FD;Fung, CP
Contributors:	Division of Infectious Diseases
Abstract:	Background/Purpose(s): Patients receiving hemodialysis infected with methicillin-resistantStaphylococcus aureus (MRSA) have been considered to have healthcare-associated (HA) infec-tions, but strains with community-associated (CA) characteristics have also been identi?ed inthis population. The authors compared infections of the two strains among patients with end-stage renal disease.Methods: From January 2004 to December 2008 the authors analyzed the demographic andmicrobiologic data of 57 patients with community-onset (defined as a positive culture obtained 48 hours after admission) MRSA bacteremia and end-stage renal disease at a 2900-bedtertiary medical center. MRSA isolate with staphylococcal cassette chromosome mec (SCCmec)type II/III was classi?ed as HA strains, and SCCmec type IV/V as CA strains.Results: Forty-seven patients (82%) had HA-MRSA strains and 10 patients (18%) had CA-MRSAstrains. The major clones of HA-MRSA were sequence type (ST) 5 with SCCmec type II andstaphylococcal protein A (spa) t002 as well as ST239 carrying SCCmec type III and spa t037.The CA-MRSA strains were predominantly ST59, more susceptible to non- b -lactam antimicro-bial agents, and had a higher percentage of carrying the Panton-Valentine leukocidin genein comparision with the HA-MRSA strains. Patients infected with HA-MRSA isolates had a higheroverall mortality (57.4%, p Z 0.012). In multivariate analysis, male patients were more likelyto be infected with HA-MRSA isolates than CA-MRSA strains (p Z 0.037), and a history ofreceiving urinary catheterization within 1 year prior to bacteremia onset (p Z 0.047) is anindependent risk factor to acquiring HA-MRSA strains.Conclusion: Patients undergoing dialysis and infected with HA-MRSA strains had highermortality rates and were more commonly associated with urinary catheterization within 1 yearbefore bacteremia.
Date:	2013-04
Relation:	Journal of Microbiology, Immunology and Infection. 2013 Apr;46(2):96-103.
Link to:	http://dx.doi.org/10.1016/j.jmii.2012.02.004
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1684-1182&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000344877200005
Cited Times(Scopus):	http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84876136581
Appears in Collections:	[Shu-Chen Kuo] Periodical Articles

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