Lack of association between genotypes and haematogenous seeding infections in a large cohort of patients with methicillin-resistant Staphylococcus aureus bacteraemia from 21 Spanish hospitals
Por:
Gasch, O, Camoez, M, Dominguez, MA, Padilla, B, Pintado, V, Almirante, B, Martin-Gandul, C, Lopez-Medrano, F, de Gopegui, ER, Blanco, JR, Garcia-Pardo, G, Calbo, E, Horcajada, JP, Granados, A, Jover-Saenz, A, Duenas, C, Pujol, M, Benito, N, Mirelis B., REIPI GEIM Study Grp
Publicada:
1 abr 2014
Resumen:
There is increasing concern regarding the association between certain methicillin-resistant Staphylococcus aureus (MRSA) genotypes and poor clinical outcome. To assess this issue, a large cohort of 579 subjects with MRSA bacteraemia was prospectively followed from June 2008 to December 2009, in 21 hospitals in Spain. Epidemiology, clinical data, therapy, and outcome were recorded. All MRSA strains were analysed in a central laboratory. Presence of a haematogenous seeding infection was the dependent variable in an adjusted logistic regression model. Of the 579 patients included in the study, 84 (15%) had haematogenous seeding infections. Microdilution vancomycin median MIC (IQR) was 0.73 (0.38-3) mg/L. Most MRSA isolates (n=371; 67%) belonged to Clonal Complex 5 (CC5) and carried an SCCmec element type IV and agr type 2. Isolates belonging to ST8-agr1-SCCmecIV, ST22-agr1-SCCmecIV and ST228-agr2-SCCmecIa single locus variant of ST5accounted for 8%, 9% and 9% of the isolates, respectively. After adjusting by clinical variables, any of the clones was associated with increased risk of haematogenous seeding infections. Higher vancomycin MIC was not identified as an independent risk factor, either. In contrast, persistent bacteraemia (OR 4.2; 2.3-7.8) and non-nosocomial acquisition (3.0; 1.7-5.6) were associated with increased risk.
Filiaciones:
Gasch, O:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona 08907, Spain
Camoez, M:
Hosp Univ Bellvitge, Dept Microbiol, Barcelona 08907, Spain
Dominguez, MA:
Hosp Univ Bellvitge, Dept Microbiol, Barcelona 08907, Spain
Padilla, B:
Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid, Spain
Pintado, V:
Hosp Ramon & Cajal, Dept Infect Dis, E-28034 Madrid, Spain
Almirante, B:
Hosp Valle De Hebron, Dept Infect Dis, Barcelona, Spain
Martin-Gandul, C:
Hosp Virgen Rocio, Dept Infect Dis, Seville, Spain
Lopez-Medrano, F:
Hosp Univ 12 Octubre, Dept Infect Dis, Madrid, Spain
de Gopegui, ER:
Hosp Univ Son Espases, Dept Microbiol, Palma de Mallorca, Spain
Blanco, JR:
Hosp San Pedro, Dept Infect Dis, Logrono, Spain
Garcia-Pardo, G:
Hosp Joan 23, Prevent Med Unit, Tarragona, Spain
Calbo, E:
Hosp Mutua, Dept Infect Dis, Terrassa, Spain
Horcajada, JP:
Hosp Mar, Dept Infect Dis, Barcelona, Spain
Granados, A:
Corporacio Sanitaria Parc Tauli, Dept Infect Dis, Sabadell, Spain
Jover-Saenz, A:
Hosp Arnau Vilanova, Dept Med, Lleida, Spain
Duenas, C:
Hosp Burgos, Dept Med, Burgos, Spain
Pujol, M:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona 08907, Spain
Benito, N:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Mirelis B.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
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