Skip to main content Accessibility help
×
Home

Epidemiology of Methicillin-Resistant Staphylococcus aureus Bloodstream Coinfection Among Adults With Candidemia in Atlanta, GA, 2008–2012

  • Jessica Reno (a1) (a2) (a3), Saumil Doshi (a4), Amy K. Tunali (a2) (a3) (a4), Betsy Stein (a2) (a3) (a4), Monica M. Farley (a2) (a3) (a4), Susan M. Ray (a2) (a4) and Jesse T. Jacob (a2) (a4)...

Abstract

BACKGROUND

Patients with candidemia are at risk for other invasive infections, such as methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI).

OBJECTIVE

To identify the risk factors for, and outcomes of, BSI in adults with Candida spp. and MRSA at the same time or nearly the same time.

DESIGN

Population-based cohort study.

SETTING

Metropolitan Atlanta, March 1, 2008, through November 30, 2012.

PATIENTS

All residents with Candida spp. or MRSA isolated from blood.

METHODS

The Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.

RESULTS

Among 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%, P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03–2.86]) predicted coinfection.

CONCLUSIONS

A small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.

Infect. Control Hosp. Epidemiol. 2015;36(11):1298–1304

Copyright

Corresponding author

Address correspondence to Jesse T. Jacob, MD, Orr Building, Ste 1020, 550 Peachtree St NE, Atlanta, GA 30308 (jtjacob@emory.edu).

Footnotes

Hide All

Presented in part: IDWeek 2013; San Francisco, California; October 2013; and Southern Regional Meeting 2013; New Orleans, Louisiana; February 2013.

Footnotes

References

Hide All
1. Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239244.
2. Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309317.
3. Sancho, S, Artero, A, Zaragoza, R, Camarena, JJ, Gonzalez, R, Nogueira, JM. Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients. Eur J Clin Microbiol Infect Dis 2012;31:17911796.
4. Lin, JN, Lai, CH, Chen, YH, et al. Characteristics and outcomes of polymicrobial bloodstream infections in the emergency department: a matched case-control study. Acad Emerg Med 2010;17:10721079.
5. Sutter, D, Stagliano, D, Braun, L, et al. Polymicrobial bloodstream infection in pediatric patients: risk factors, microbiology, and antimicrobial management. Pediatr Infect Dis J 2008;27:400405.
6. Weinstein, MP, Relier, LB, Murphy, JR. Clinical importance of polymicrobial bacteremia. Diagn Microbiol Infect Dis 1986;185:185196.
7. Bouza, E, Burillo, A, Munoz, P, Guinea, J, Marin, M, Rodriguez-Creixems, M. Mixed bloodstream infections involving bacteria and Candida spp. J Antimicrob Chemother 2013;68:18811888.
8. Dyess, DL, Garrison, RN, Fry, DE. Candida sepsis: implications of polymicrobial blood-borne infection. Arch Surg 1985;120:345348.
9. Pulimood, S, Ganesan, L, Alangaden, G, Chandrasekar, P. Polymicrobial candidemia. Diagn Microbiol Infect Dis 2002;44:353357.
10. Arendrup, MC, Bruun, B, Christensen, JJ, et al. National surveillance of fungemia in Denmark (2004 to 2009). J Clin Microbiol 2011;49:325334.
11. Klotz, SA, Chasin, BS, Powell, B, Gaur, NK, Lipke, PN. Polymicrobial bloodstream infections involving Candida species: analysis of patients and review of the literature. Diagn Microbiol Infect Dis 2007;59:401406.
12. Kim, S-H, Yoon, YK, Kim, MJ, Sohn, JW. Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections. Clin Microbiol Infect 2013;19:6268.
13. Annual estimates of the resident population: April 1, 2010 to July 1, 2012. US Census Bureau American FactFinder website. http://factfinder2.census.gov. Published 2012. Accessed April 30, 2014.
14. Lesse, AJ, Mylotte, JM. Clinical and molecular epidemiology of nursing home-associated Staphylococcus aureus bacteremia. Am J Infect Control 2006;34:642650.
15. Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients. Arch Intern Med 2003;163:972978.
16. Roberts, RR, Hota, B, Ahmad, I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis 2009;49:11751184.
17. Azoulay, E, Timsit, J-Fo, Tafflet, M, et al. Candida colonization of the respiratory tract and subsequent Pseudomonas ventilator-associated pneumonia. Chest 2006;129:110117.
18. Akagawa, G, Abe, S, Yamaguchi, H. Mortality of Candida albicans–infected mice is facilitated by superinfection of Escherichia coli or administration of its lipopolysaccharide. J Infect Dis 1995;171:15391544.
19. Carlson, E. Effect of strain of Staphylococcus aureus on synergism with Candida albicans resulting in mouse mortality and morbidity. Infect Immun 1983;42:285292.
20. Grillot, R, Portmann-Coffin, V, Ambroise-Thomas, P. Growth inhibition of pathogenic yeasts by Pseudomonas aeruginosa in vitro: clinical implications in blood cultures. Mycoses 1994;37:343347.
21. Kaleli, I, Cevahir, N, Demir, M, Yildirim, U, Sahin, R. Anticandidal activity of Pseudomonas aeruginosa strains isolated from clinical specimens. Mycoses 2006;50:7478.
22. Peleg, AY, Tampakakis, E, Fuchs, BB, Eliopoulos, GM, Moellering, RC Jr, Mylonakis, E. Prokaryote-eukaryote interactions identified by using Caenorhabditis elegans . Proc Natl Acad Sci U S A 2008;105:1458514590.
23. Peters, BM, Jabra-Rizk, MA, Scheper, MA, Leid, JG, Costerton, JW, Shirtliff, ME. Microbial interactions and differential protein expression in Staphylococcus aureus–Candida albicans dual-species biofilms. FEMS Immunol Med Microbiol 2010;59:493503.
24. Harriott, MM, Noverr, MC. Ability of Candida albicans mutants to induce Staphylococcus aureus vancomycin resistance during polymicrobial biofilm formation. Antimicrob Agents Chemother 2010;54:37463755.
25. Harriott, MM, Noverr, MC. Candida albicans and Staphylococcus aureus form polymicrobial biofilms: effects on antimicrobial resistance. Antimicrob Agents Chemother 2009;53:39143922.
26. Klaerner, HG, Uknis, ME, Acton, RD, Dahlberg, PS, Carlone-Jambor, C, Dunn, DL. Candida albicans and Escherichia coli are synergistic pathogens during experimental microbial peritonitis. J Surg Res 1997;70:161165.
27. Pathak, AK, Sharma, S, Shrivastva, P. Multi-species biofilm of Candida albicans and non–Candida albicans Candida species on acrylic substrate. J Appl Oral Sci 2012;20:7075.

Epidemiology of Methicillin-Resistant Staphylococcus aureus Bloodstream Coinfection Among Adults With Candidemia in Atlanta, GA, 2008–2012

  • Jessica Reno (a1) (a2) (a3), Saumil Doshi (a4), Amy K. Tunali (a2) (a3) (a4), Betsy Stein (a2) (a3) (a4), Monica M. Farley (a2) (a3) (a4), Susan M. Ray (a2) (a4) and Jesse T. Jacob (a2) (a4)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed