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Shey-Ying Chen, Chun-Hsing Liao, Jiun-Ling Wang, Wen-Chu Chiang, Mei-Shu Lai, Wei-Chu Chie, Wen-Jone Chen, Shan-Chwen Chang, Po-Ren Hsueh, Methicillin-Resistant Staphylococcus aureus (MRSA) Staphylococcal Cassette Chromosome mec Genotype Effects Outcomes of Patients With Healthcare-Associated MRSA Bacteremia Independently of Vancomycin Minimum Inhibitory Concentration, Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages 1329–1337, https://doi.org/10.1093/cid/cis717
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Abstract
Background. Recent evidence has shown that community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is less virulent than traditional hospital-associated MRSA. We explored whether the antimicrobial susceptibilities of the different strains account for their disparity in clinical virulence.
Methods. This 10-year retrospective cohort study enrolled 291 patients with community-onset, healthcare-associated MRSA bacteremia. The vancomycin minimum inhibitory concentration (MIC) and staphylococcal cassette chromosome mec (SCCmec) type were determined for all isolates. CA-MRSA was defined as an isolate possessing the SCCmec type IV or V genes, and hospital-associated MRSA (HA-MRSA) was defined as an isolate possessing SCCmec type I, II, or III genes. Low and high vancomycin MICs were defined as MICs of ≤1 and ≥2 μg/mL, respectively. Patients with bacteremia due to CA-MRSA with a low vancomycin MIC (n = 111), due to HA-MRSA with a low vancomycin MIC (n = 127), or due to HA-MRSA with a high vancomycin MIC (n = 47) entered the outcome analysis. The outcomes of the 2 HA-MRSA bacteremia groups were compared to those of the CA-MRSA bacteremia group.
Results. Treatment failure was observed in 35 (31.5%), 59 (46.5%), and 27 (57.4%) of patients with low-vancomycin-MIC CA-MRSA, low-vancomycin-MIC HA-MRSA, and high-vancomycin-MIC HA-MRSA bacteremia, respectively. After adjustment for potential confounding factors, the risk of treatment failure was significantly higher among patients with low-vancomycin-MIC HA-MRSA (adjusted odds ratio [aOR], 1.853; 95% confidence interval [CI], 1.006–3.413) and high-vancomycin-MIC HA-MRSA (aOR, 2.393; 95% CI, 1.079–5.309), compared with patients with low-vancomycin-MIC CA-MRSA.
Conclusions. The higher risk for treatment failure among patients with traditional hospital-associated MRSA infections, compared with patients with CA-MRSA infections, is independent of the vancomycin MIC, suggesting a potential intrinsic strain-specific virulence effect.
