Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-02T05:40:09.933Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus Strains as a Cause of Healthcare-Associated Bloodstream Infections in Korea

Published online by Cambridge University Press:  02 January 2015

Sun Hee Park ,
Chulmin Park ,
Jin-Hong Yoo ,
Su-Mi Choi ,
Jung-Hyun Choi ,
Hyun-Ho Shin ,
Dong-Gun Lee ,
Seungok Lee ,
JaYoung Kim  and
So Eun Choi
...Show all authors
Sun Hee Park
Affiliation:
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea
Chulmin Park
Affiliation:
Catholic Research Institutes of Medical Science, Catholic University of Korea, Seoul, Korea
Jin-Hong Yoo
Affiliation:
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea
Su-Mi Choi
Affiliation:
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea
Jung-Hyun Choi
Affiliation:
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea
Hyun-Ho Shin
Affiliation:
Catholic Research Institutes of Medical Science, Catholic University of Korea, Seoul, Korea
Dong-Gun Lee
Affiliation:
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea
Seungok Lee
Affiliation:
Department of Laboratory Medicine, Catholic University of Korea, Seoul, Korea
JaYoung Kim
Affiliation:
Department of Laboratory Medicine, Catholic University of Korea, Seoul, Korea
So Eun Choi
Affiliation:
Infection Control Office, Catholic University of Korea, Seoul, Korea
Young-Mi Kwon
Affiliation:
Infection Control Office, Catholic University of Korea, Seoul, Korea
Wan-Shik Shin*
Affiliation:
Department of Internal Medicine, Catholic University of Korea, Seoul, Korea
*
Department of Internal Medicine, St. Mary's Hospital, 62, Yoido-Dong, Youngdeungpo-Gu, Seoul, Korea150-713 (zenithbr@catholic.ac.kr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

The prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains causing bloodstream infection (BSI) has not been studied in Korea.

Objective.

We sought to determine the prevalence of CA-MRSA strains among isolates recovered from patients with MRSA BSIs and to explore epidemiological changes in Korea. We also sought to evaluate clinical characteristics relevant to the development of healthcare-associated BSIs.

Methods.

We prospectively collected consecutive MRSA isolates from patients with BSI at 4 hospitals from July 1 through November 30, 2007, and we also included MRSA isolates recovered from culture of blood samples collected during a previous year (October 1, 2004 through September 30, 2005) at a different hospital. Molecular typing studies were performed, including pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, Staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. We compared the clinical characteristics and outcomes of patients with healthcare-associated BSI due to CA-MRSA strains with those of patients with healthcare-associated BSI due to healthcare-associated MRSA (HA-MRSA) strains.

Results.

There were 76 cases of MRSA BSI, of which 4 (5.3%) were community-associated and 72 (94.7%) were healthcare-associated. Among the 72 HA-MRSA BSIs, 18 (25%) were community onset, and 54 (75%) were hospital onset. PFGE type D-ST72–spa B-SCCmec type IVA MRSA, the predominant genotype of CA-MRSA in Korea, accounted for 19 (25%) of all 76 MRSA BSIs, including 17 (23.6%) of 72 HA-MRSA BSIs and 11 (20.8%) of 53 hospital-onset HA-MRSA BSIs. Patients with healthcare-associated BSIs due to CA-MRSA strains carrying SCCmec type IVA tended to have fewer healthcare-associated risk factors, compared with patients with healthcare-associated BSIs due to HA-MRSA strains carrying other SCCmec types. The presence of a central venous catheter or other invasive device was the only independent factor differentiating patients infected with hospital-associated genotype strains from patients infected with other strains. Clinical outcomes were similar between both groups.

Conclusions.

CA-MRSA strains are emerging as a major cause of BSI in healthcare settings in Korea. This changing epidemiology of MRSA poses a challenge to public health and infection control in hospital settings.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 2 , February 2009 , pp. 146 - 155
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lo, WT, Lin, WJ, Tseng, MH, Wang, SR, Chu, ML, Wang, CC. Methicillin-resistant Staphylococcus aureus in children, Taiwan. Emerg Infect Dis 2006;12:1267–1270.Google Scholar
2.Vandenesch, F, Naimi, T, Enright, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003;9:978–984.Google Scholar
3.Zetola, N, Francis, JS, Nuermberger, EL, Bishai, WR. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2005;5:275–286.CrossRefGoogle ScholarPubMed
4.Fridkin, SK, Hageman, JC, Morrison, M, et al.Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436–1444.Google Scholar
5.Okuma, K, Iwakawa, K, Turnidge, JD, et al.Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002;40:4289–4294.Google Scholar
6.Tenover, FC, McDougal, LK, Goering, RV, et al.Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol 2006;44:108–118.Google Scholar
7.Naimi, TS, LeDell, KH, Como-Sabetti, K, et al.Comparison of communityand health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976–2984.Google Scholar
8.Choi, SH, Chung, JW. A fatal case of infective endocarditis caused by community—associated methicillin-resistant Staphylococcus aureus ST72 in Korea. Korean J Clin Microbiol 2008;11:129–131.Google Scholar
9.Kim, SY, Lee, HS, Kim, JY, et al.A case of acute pyelonephritis caused by community-acquired methicillin-resistant Staphylococcus aureus [in Korean]. Infect Chemother 2007;39:100–103.Google Scholar
10.Park, C, Lee, DG, Choi, SM, et al.A case of perianal abscess due to Panton-Valentine Leukocidin positive community-associated methicillin-resistant Staphylococcus aureus: report in Korea and literature review from the far East. Infect Chemother 2008;40:121–126.Google Scholar
11.Kim, ES, Song, JS, Lee, HJ, et al.A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea. J Antimicrob Chemother 2007;60:1108–1114.Google Scholar
12.Kim, HB. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) [in Korean]. Korean J Intern Med 2007;72:120–130.Google Scholar
13.Park, C, Lee, DG, Kim, SW, et al.Predominance of community-associated methicillin-resistant Staphylococcus aureus strains carrying staphylococcal chromosome cassette mec type IVA in South Korea. J Clin Microbiol 2007;45:4021–4026.CrossRefGoogle ScholarPubMed
14.Cha, HY, Moon, DC, Choi, CH, et al.Prevalence of the ST239 clone of methicillin-resistant Staphylococcus aureus and differences in antimicrobial susceptibilities of ST239 and ST5 clones identified in a Korean hospital. J Clin Microbiol 2005;43:3610–3614.CrossRefGoogle Scholar
15.Ko, KS, Kim, YS, Song, JH, et al.Genotypic diversity of methicillin-resistant Staphylococcus aureus isolates in Korean hospitals. Antimicrob Agents Chemother 2005;49:3583–3585.Google Scholar
16.Jeong, HY, Lee, JE, Choi, BK, et al.Molecular epidemiology of community-associated antimicrobial-resistant Staphylococcus aureus in Seoul, Korea (2003): pervasiveness of multidrug-resistant SCCmec type II methicillin-resistant S. aureus. Microb Drug Resist 2007;13:178–185.Google Scholar
17.Ma, SH, Kim, EJ, Lee, JC, Lee, YS. Clinical features and microbial characteristics of community-acquired MRSA staphylococcal scaled skin syndrome [in Korean]. Infect Chemother 2005;37(Supp 2):S232.Google Scholar
18.Cuevas, O, Cercenado, E, Bouza, E, et al.Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Spain: a multicentre prevalence study (2002). Clin Microbiol Infect 2007;13:250–256.Google Scholar
19.de A Trindade, P, Pacheco, RL, Costa, SF, et al.Prevalence of SCCmec type IV in nosocomial bloodstream isolates of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:3435–3437.Google Scholar
20.Donnio, PY, Preney, L, Gautier-Lerestif, AL, Avril, JL, Lafforgue, N. Changes in staphylococcal cassette chromosome type and antibiotic resistance profile in methicillin-resistant Staphylococcus aureus isolates from a French hospital over an 11-year period. J Antimicrob Chemother 2004;53:808–813.Google Scholar
21.Huang, YH, Tseng, SP, Hu, JM, Tsai, JC, Hsueh, PR, Teng, LJ. Clonal spread of SCCmec type IV methicillin-resistant Staphylococcus aureus between community and hospital. Clin Microbiol Infect 2007;13:717–724.Google Scholar
22.Ko, KS, Park, S, Peck, KR, et al.Molecular characterization of methicillin-resistant Staphylococcus aureus spread by neonates transferred from primary obstetrics clinics to a tertiary care hospital in Korea. Infect Control Hosp Epidemiol 2006;27:593–597.Google Scholar
23.Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46:787–794.CrossRefGoogle ScholarPubMed
24.Saiman, L, O’Keefe, M, Graham, PL3rd, et al.Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003;37:1313–1319.CrossRefGoogle ScholarPubMed
25.Seybold, U, Kourbatova, EV, Johnson, JG, et al.Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42:647–656.CrossRefGoogle Scholar
26.Gonzalez, BE, Rueda, AM, Shelburne, SA 3rd, Musher, DM, Hamill, RJ, Hulten, KG. Community-associated strains of methicillin-resistant Staphylococcus aureus as the cause of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27:1051–1056.Google Scholar
27.Klevens, RM, Morrison, MA, Fridkin, SK, et al.Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infect Dis 2006;12:1991–1993.Google Scholar
28.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care Setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
29.Mermel, LA, Farr, BM, Sherertz, RJ, et al.Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249–1272.Google Scholar
30.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;96:200–209.CrossRefGoogle ScholarPubMed
31.Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998;158:182–189.Google Scholar
32.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
33.Davis, SL, Rybak, MJ, Amjad, M, Kaatz, GW, McKinnon, PS. Characteristics of patients with healthcare-associated infection due to SCCmec type IV methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2006;27:1025–1031.Google Scholar
34.Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 17th informational supplement. Wayne, PA: CLSI; 2007:M100-S17.Google Scholar
35.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–5120.Google Scholar
36.Enright, MC, Day, NP, Davies, CE, Peacock, SJ, Spratt, BG. Multilocus sequence typing for characterization of methicillin-resistant and meth-icillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000;38:1008–1015.CrossRefGoogle ScholarPubMed
37.Shopsin, B, Gomez, M, Montgomery, SO, et al.Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol 1999;37:3556–3563.CrossRefGoogle ScholarPubMed
38.Ruppitsch, W, Indra, A, Stoger, A, et al.Classifying spa types in complexes improves interpretation of typing results for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006;44:2442–2448.CrossRefGoogle ScholarPubMed
39.Staphylococcus aureus database. Available at: http://saureus.mlst.net/. Accessed March 26, 2008.Google Scholar
40.Aires-de-Sousa, M, Boye, K, de Lencastre, H, et al.High interlaboratory reproducibility of DNA sequence-based typing of bacteria in a multi-center study. J Clin Microbiol 2006;44:619–621.Google Scholar
41.Ridom SpaServer. Available at: http://www.ridom.de/spaserver. Accessed May 2, 2008.Google Scholar
42.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;46:2155–2161.Google Scholar
43.Kim, HB, Jang, HC, Nam, HJ, et al.In vitro activities of 28 antimicrobial agents against Staphylococcus aureus isolates from tertiary-care hospitals in Korea: a nationwide survey. Antimicrob Agents Chemother 2004;48:1124–1127.Google Scholar
44.Maree, CL, Daum, RS, Boyle-Vavra, S, Matayoshi, K, Miller, LG. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 2007;13:236242.Google Scholar
45.Amorim, ML, Faria, NA, Oliveira, DC, et al.Changes in the clonal nature and antibiotic resistance profiles of methicillin-resistant Staphylococcus aureus isolates associated with spread of the EMRSA-15 clone in a tertiary care Portuguese hospital. J Clin Microbiol 2007;45:2881–2888.CrossRefGoogle Scholar
46.Pan, ES, Diep, BA, Carleton, HA, et al.Increasing prevalence of methicillin-resistant Staphylococcus aureus infection in California jails. Clin Infect Dis 2003;37:1384–1388.Google Scholar
47.de Franchis, R. Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop oh methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005;43:167–176.Google Scholar
48.Gines, A, Escorsell, A, Gines, P, et al.Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993;105:229–236.Google Scholar
49.Laupland, KB, Ross, T, Gregson, DB. Staphylococcus aureus bloodstream infections: risk factors, outcomes, and the influence of methicillin resistance in Calgary, Canada, 2000–2006. J Infect Dis 2008;198:336–343.Google Scholar
50.Kaye, KS, Anderson, DJ, Choi, Y, Link, K, Thacker, P, Sexton, DJ. The deadly toll of invasive methicillin-resistant Staphylococcus aureus infection in community hospitals. Clin Infect Dis 2008;46:1568–1577.Google Scholar
51.Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008;47:176–181.Google Scholar