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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
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
Corresponding
E-mail address:

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
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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