Top

Published in:

01-02-2013 | Clinical and Epidemiological Study

agr dysfunction and persistent methicillin-resistant Staphylococcus aureus bacteremia in patients with removed eradicable foci

Authors: S.-Y. Park, Y. P. Chong, H. J. Park, K.-H. Park, S. M. Moon, J.-Y. Jeong, M.-N. Kim, S.-H. Kim, S.-O. Lee, S.-H. Choi, J. H. Woo, Y. S. Kim

Published in: Infection | Issue 1/2013

Abstract

Purpose

Persistent Staphylococcus aureus bacteremia (SAB) has been observed in patients with eradicated foci, but there are few studies of the risk factors and clinical outcomes of persistent bacteremia. This study determined the risk factors for persistent methicillin-resistant S. aureus (MRSA) bacteremia in patients without retained eradicable foci, including genotypic characteristics.

Methods

All adult SAB patients were investigated between 2008 and 2010. Persistent bacteremia was defined as bacteremia lasting >7 days after treatment and patients were monitored prospectively. The study included patients without retained eradicable foci, e.g., removed prosthetic devices and intravenous catheters removed after diagnosis, and those without metastatic infections.

Results

Persistent bacteremia occurred in 36 % (31/87) SAB patients with eradicated foci. There were no significant differences in successful defervescence (2.0 vs. 2.0 days, P = 0.55) and total length of hospital stay after bacteremia in the persistent bacteremia group and resolved bacteremia group (P = 0.32). The difference in MRSA bacteremia-related 30-day mortality with persistent bacteremia and resolved bacteremia was not significant (P = 0.12). However, agr dysfunction was higher in persistent bacteremia patients (94 %) than those with resolved bacteremia (75 %, P = 0.03). Multivariate analysis using a logistic regression model found that only agr dysfunction [odds ratio (OR) 4.83, 95 % confidence interval (CI) 1.02–22.89, P = 0.04] was an independent risk factor for persistent bacteremia.

Conclusions

This study suggests that persistent bacteremia with eradicated foci might not adversely affect the outcome for MRSA bacteremia patients. agr dysfunction in S. aureus was significantly associated with persistent bacteremia.

Park SY, Son JS, Oh IH, Choi JM, Lee MS. Clinical impact of methicillin-resistant Staphylococcus aureus bacteremia based on propensity scores. Infection. 2011;39:141–7.PubMedCrossRef

Fowler VG Jr, Sakoulas G, McIntyre LM, Meka VG, Arbeit RD, Cabell CH, Stryjewski ME, Eliopoulos GM, Reller LB, Corey GR, Jones T, Lucindo N, Yeaman MR, Bayer AS. Persistent bacteremia due to methicillin-resistant Staphylococcus aureus infection is associated with agr dysfunction and low-level in vitro resistance to thrombin-induced platelet microbicidal protein. J Infect Dis. 2004;190:1140–9.PubMedCrossRef

Hawkins C, Huang J, Jin N, Noskin GA, Zembower TR, Bolon M. Persistent Staphylococcus aureus bacteremia: an analysis of risk factors and outcomes. Arch Intern Med. 2007;167:1861–7.PubMedCrossRef

Khatib R, Johnson LB, Sharma M, Fakih MG, Ganga R, Riederer K. Persistent Staphylococcus aureus bacteremia: incidence and outcome trends over time. Scand J Infect Dis. 2009;41:4–9.PubMedCrossRef

Neuner EA, Casabar E, Reichley R, McKinnon PS. Clinical, microbiologic, and genetic determinants of persistent methicillin-resistant Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis. 2010;67:228–33.PubMedCrossRef

Lin SH, Liao WH, Lai CC, Liao CH, Tan CK, Wang CY, Huang YT, Hsueh PR. Risk factors for mortality in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia in a tertiary care hospital in Taiwan. J Antimicrob Chemother. 2010;65:1792–8.PubMedCrossRef

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40.PubMedCrossRef

Jensen AG, Wachmann CH, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med. 2002;162:25–32.PubMedCrossRef

Kim SH, Park WB, Lee KD, Kang CI, Kim HB, Oh MD, Kim EC, Choe KW. Outcome of Staphylococcus aureus bacteremia in patients with eradicable foci versus noneradicable foci. Clin Infect Dis. 2003;37:794–9.PubMedCrossRef

10.

Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96:200–9.PubMedCrossRef

11.

Fowler VG Jr, Justice A, Moore C, Benjamin DK Jr, Woods CW, Campbell S, Reller LB, Corey GR, Day NP, Peacock SJ. Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis. 2005;40:695–703.PubMedCrossRef

12.

Wootton M, Howe RA, Hillman R, Walsh TR, Bennett PM, MacGowan AP. A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J Antimicrob Chemother. 2001;47:399–403.PubMedCrossRef

13.

Traber K, Novick R. A slipped-mispairing mutation in AgrA of laboratory strains and clinical isolates results in delayed activation of agr and failure to translate delta- and alpha-haemolysins. Mol Microbiol. 2006;59:1519–30.PubMedCrossRef

14.

Schweizer ML, Furuno JP, Sakoulas G, Johnson JK, Harris AD, Shardell MD, McGregor JC, Thom KA, Perencevich EN. Increased mortality with accessory gene regulator (agr) dysfunction in Staphylococcus aureus among bacteremic patients. Antimicrob Agents Chemother. 2011;55:1082–7.PubMedCrossRef

15.

Sakoulas G, Eliopoulos GM, Moellering RC Jr, Wennersten C, Venkataraman L, Novick RP, Gold HS. Accessory gene regulator (agr) locus in geographically diverse Staphylococcus aureus isolates with reduced susceptibility to vancomycin. Antimicrob Agents Chemother. 2002;46:1492–502.PubMedCrossRef

16.

Butterfield JM, Tsuji BT, Brown J, Ashley ED, Hardy D, Brown K, Forrest A, Lodise TP. Predictors of agr dysfunction in methicillin-resistant Staphylococcus aureus (MRSA) isolates among patients with MRSA bloodstream infections. Antimicrob Agents Chemother. 2011;55:5433–7.PubMedCrossRef

17.

Campbell SJ, Deshmukh HS, Nelson CL, Bae IG, Stryjewski ME, Federspiel JJ, Tonthat GT, Rude TH, Barriere SL, Corey R, Fowler VG Jr. Genotypic characteristics of Staphylococcus aureus isolates from a multinational trial of complicated skin and skin structure infections. J Clin Microbiol. 2008;46:678–84.PubMedCrossRef

18.

Jarraud S, Mougel C, Thioulouse J, Lina G, Meugnier H, Forey F, Nesme X, Etienne J, Vandenesch F. Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect Immun. 2002;70:631–41.PubMedCrossRef

19.

Diep BA, Carleton HA, Chang RF, Sensabaugh GF, Perdreau-Remington F. Roles of 34 virulence genes in the evolution of hospital- and community-associated strains of methicillin-resistant Staphylococcus aureus. J Infect Dis. 2006;193:1495–503.PubMedCrossRef

20.

Peacock SJ, Moore CE, Justice A, Kantzanou M, Story L, Mackie K, O’Neill G, Day NP. Virulent combinations of adhesin and toxin genes in natural populations of Staphylococcus aureus. Infect Immun. 2002;70:4987–96.PubMedCrossRef

21.

Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol. 2000;38:1008–15.PubMed

22.

Oliveira DC, de Lencastre H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2002;46:2155–61.PubMedCrossRef

23.

Seidl K, Bayer AS, Fowler VG Jr, McKinnell JA, Abdel Hady W, Sakoulas G, Yeaman MR, Xiong YQ. Combinatorial phenotypic signatures distinguish persistent from resolving methicillin-resistant Staphylococcus aureus bacteremia isolates. Antimicrob Agents Chemother. 2011;55:575–82.

24.

Siegman-Igra Y, Reich P, Orni-Wasserlauf R, Schwartz D, Giladi M. The role of vancomycin in the persistence or recurrence of Staphylococcus aureus bacteraemia. Scand J Infect Dis. 2005;37:572–8.PubMedCrossRef

25.

Novick RP, Geisinger E. Quorum sensing in staphylococci. Annu Rev Genet. 2008;42:541–64.PubMedCrossRef

26.

Sakoulas G, Eliopoulos GM, Fowler VG Jr, Moellering RC Jr, Novick RP, Lucindo N, Yeaman MR, Bayer AS. Reduced susceptibility of Staphylococcus aureus to vancomycin and platelet microbicidal protein correlates with defective autolysis and loss of accessory gene regulator (agr) function. Antimicrob Agents Chemother. 2005;49:2687–92.PubMedCrossRef

27.

Traber KE, Lee E, Benson S, Corrigan R, Cantera M, Shopsin B, Novick RP. agr function in clinical Staphylococcus aureus isolates. Microbiology. 2008;154:2265–74.PubMedCrossRef

28.

Moise PA, Sakoulas G, Forrest A, Schentag JJ. Vancomycin in vitro bactericidal activity and its relationship to efficacy in clearance of methicillin-resistant Staphylococcus aureus bacteremia. Antimicrob Agents Chemother. 2007;51:2582–6.PubMedCrossRef

29.

Tsuji BT, Rybak MJ, Lau KL, Sakoulas G. Evaluation of accessory gene regulator (agr) group and function in the proclivity towards vancomycin intermediate resistance in Staphylococcus aureus. Antimicrob Agents Chemother. 2007;51:1089–91.PubMedCrossRef

30.

Sakoulas G, Eliopoulos GM, Moellering RC Jr, Novick RP, Venkataraman L, Wennersten C, DeGirolami PC, Schwaber MJ, Gold HS. Staphylococcus aureus accessory gene regulator (agr) group II: is there a relationship to the development of intermediate-level glycopeptide resistance? J Infect Dis. 2003;187:929–38.PubMedCrossRef

31.

Moise-Broder PA, Sakoulas G, Eliopoulos GM, Schentag JJ, Forrest A, Moellering RC Jr. Accessory gene regulator group II polymorphism in methicillin-resistant Staphylococcus aureus is predictive of failure of vancomycin therapy. Clin Infect Dis. 2004;38:1700–5.PubMedCrossRef

32.

Sakoulas G, Moellering RC Jr, Eliopoulos GM. Adaptation of methicillin-resistant Staphylococcus aureus in the face of vancomycin therapy. Clin Infect Dis. 2006;42(Suppl 1):S40–50.PubMedCrossRef

Title: agr dysfunction and persistent methicillin-resistant Staphylococcus aureus bacteremia in patients with removed eradicable foci
Authors: S.-Y. Park
Y. P. Chong
H. J. Park
K.-H. Park
S. M. Moon
J.-Y. Jeong
M.-N. Kim
S.-H. Kim
S.-O. Lee
S.-H. Choi
J. H. Woo
Y. S. Kim
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Infection / Issue 1/2013
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-012-0348-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

agr dysfunction and persistent methicillin-resistant Staphylococcus aureus bacteremia in patients with removed eradicable foci

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Why is antimicrobial de-escalation under-prescribed for urinary tract infections?

Which lumen is the source of catheter-related bloodstream infection in patients with multi-lumen central venous catheters?

Successful ganciclovir therapy in a patient with human herpesvirus-6 encephalitis after unrelated cord blood transplantation: usefulness of longitudinal measurements of viral load in cerebrospinal fluid

Targets for antibiotic and healthcare resource stewardship in inpatient community-acquired pneumonia: a comparison of management practices with National Guideline Recommendations

Kaposi’s sarcoma symmetric mucosal lesions

Community-acquired left-sided Pseudomonas aeruginosa endocarditis in a patient without intravenous drug use

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page