Community-onset versus nosocomial bloodstream infections due to methicillin-resistant Staphylococcus aureus in Spain
Abstract number: P1870
Millán A.B., Domínguez M.A., Borraz C., González M.P., Almirante B., Cercenado E., Padilla B., Pujol M., Rodríguez-Baño J.
Objectives: Community strains of methicillin-resistant Staphylococcus aureus (MRSA) are still rare in Spain, but a significant proportion of infections caused by MRSA are community-onset, healthcare-associated. The aims of this study were to compare the epidemiology and clinical features of community-onset and nosocomial bloodstream infections (BSI) due to MRSA in Spain.
Methods: Prospective cohort of cases of BSI due to MRSA from 59 Spanish hospitals during June 2003. Episodes were considered community-onset when diagnosed within 48 hours of hospital admission, and nosocomial when diagnosed subsequently. Community-onset episodes were subclassified as healthcare-associated on the bases of epidemiological data (Friedman's criteria) and molecular typing of isolates (e.g., clonal relation with typical nosocomial isolates), which was performed using PFGE and MLST.
Results: We included 64 episodes; 21 (33%) were community-onset, all of which were considered healthcare-associated. We found no significant differences between community-onset and nosocomial BSI regarding demographic features or clinical and epidemiological characteristics, except for the source of BSI: central venous catheter was more common among nosocomial episodes (39% vs 5%, p = 0.005), while the urinary tract was more common among community-onset episodes (25% vs 0%, p = 0.001). Empirical treatment was inappropriate in 86% of community-onset episodes and in 67% of nosocomial episodes (p = 0.1). Related mortality and 30-day mortality were 19% vs 23% (p = 0.7), and 19% vs 28% (p = 0.4), respectively.
Conclusions: One third of BSI due to MRSA bacteraemia in our study was considered community-onset, and all of them were healthcare-associated. The epidemiological and clinical features of community-onset and nosocomial episodes were similar, except for the sources of bacteraemia. Clinicians should be aware of the need to consider coverage against MRSA more frequently, particularly for certain infectious syndromes in patients with community sepsis and previous healthcare association.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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