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J. Clin. Microbiol. doi:10.1128/JCM.02311-06
Copyright (c) 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Epidemiology and Outcomes of Community-Associated Methicillin-Resistant Staphylococcus aureus Infection

Henry Ford Hospital, Detroit, MI; Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences and School of Medicine, Detroit, MI; William Beaumont Hospital, Royal Oak, MI; Pittsburgh Veterans Administration Medical Center, Pittsburgh, PA; and Chicago Rush University, Chicago, IL

^* To whom correspondence should be addressed. Email: mzervos1{at}hfhs.org.

	Abstract

Over a 2 year period (2003 - 2005) patients with community-associated methicillin resistant (CA-MRSA) and methicillin susceptible (CA-MSSA) Staphylococcus aureus were prospectively identified. CA-MRSA (n=102pts) and CA-MSSA (n=102pts) respectively, had a median age of 46 and 53 yrs; most common sites were skin/soft tissue (80 and 93%), respiratory tract (13 and 6%), and blood (4 and 1%). 14% of CA-MRSA vs 3 % of CA-MSSA had household contacts with similar infections (P<.01). Of CA-MRSA isolates, pulsed field gel electrophoresis (PFGE) groups were USA300 (49%), USA100 (13%), with 27 PFGE groups overall; SCCmec type IV in 71%, SCCmec type II in 29 %, Panton-Valentine-Leucocidin (PVL) in 54%. For CA-MSSA isolates there were 33 PFGE groups, USA 200 (11%), USA 600 (11%), USA 100 (10%); PVL in 10 %. 46 vs 18% of patients with CA-MRSA and CA-MSSA were hospitalized (P <.001). 50% of patients received antibiotic therapy alone, 5% surgery alone, 30% antibiotics + surgery, 3% other therapy, and 12% no treatment. Median antibiotic duration was 12 and 10d in CA-MRSA and CA-MSSA pts respectively; 48 and 56% received adequate antimicrobial therapy (P <.001). Clinical success rates of initial therapy were 61 and 84% (P <.001), recurrences were more common in the CA-MRSA group, (18 and 6%, P <.001). CA-MRSA was an independent predictor of clinical failure in multivariate analysis (OR 3.4, 95%CI 1.7-6.9). In the community setting, there was heterogeneity of molecular characteristics of strains of S. aureus. CA-MRSA infections are associated with an adverse impact on outcome compared to MSSA.