Association of bacterial genotypes and epidemiological features with treatment failure in hemodialysis patients with methicillin-resistant Staphylococcus aureus bacteremia

Abstract

ObjectivesMethicillin-resistant Staphylococcus aureus (MRSA) infections in the hemodialysis (HD) population are epidemiologically classified as healthcare-associated infections. The data about the clinical impact and bacterial characteristics of hospital-onset (HO)- and community-onset (CO)-MRSA in HD patients are scarce. The current study analyzed the difference in the clinical and molecular characteristics of HO-MRSA and CO-MRSA.MethodsWe performed a retrospective review and molecular analysis of clinical isolates from 106 HD patients with MRSA bacteremia from 2009 to 2014. CA genotypes were defined as isolates carrying the SCCmec type IV or V, and HA genotypes were defined as isolates harboring SCCmec type I, II, or III.ResultsCO-MRSA infections occurred in 76 patients, and 30 patients had HO-MRSA infections. There was no significant difference in the treatment failure rates between patients with CO-MRSA infections and those with HO-MRSA infections. CA genotypes were associated with less treatment failure (odds ratio [OR]: 0.18; 95% confidence interval [95% CI], 0.07–0.49; p = 0.001). For isolates with a vancomycin minimum inhibitory concentration (MIC) < 1.5 mg/L, the multivariate analysis revealed that HA genotypes and cuffed tunneled catheter use were associated with treatment failure. For isolates with a vancomycin MIC ≥1.5 mg/L, the only risk factor for treatment failure was a higher Pitt score (OR: 1.76; 95% CI, 1.02–3.05; p = 0.043).ConclusionCA genotypes, but not the epidemiological classification of CO-MRSA, impacted the clinical outcome of MRSA bacteremia in the HD population.

Current molecular approach for diagnosis of MRSA: a meta-narrative review

“…The dataset includes 20 different authors from Asia (n = 13), Africa (n = 5), Europe (n = 1) and America (n = 1). A total of 20 studies were included in this synthesis: seven studies employed polymerase chain reaction (PCR) for diagnosing MRSA ( 6 , 9 , 10 , 12 , 13 , 19 , 22 ), one study employed deoxyribonucleic acid (DNA) Microarray ( 7 ), two studies used DNA sequencing ( 2 , 14 ), Xpert MRSA/SA BC assay (n = 2) ( 8 , 17 ), matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF; n = 2) ( 11 , 18 ), multilocus sequence typing (MLST; n = 4) ( 15 , 20 , 23 , 24 ), GENECUBE (n = 1) ( 21 ) and staphylococcal cassette chromosome mec (SCC mec ) typing (n = 1) ( 16 ). Figure 1 is the diagrammatic flow of the study selection and list of techniques appraised in this review.…”

Insight into the Clonal Lineage and Antimicrobial Resistance of <em>Staphylococcus aureus</em> from Vascular Access Infections before and during the COVID-19 Pandemic

“…A surveillance study conducted across 18 provinces of China reported the dominance of ST59 between 2014 and 2019 [26], and Zhang et al reported the dominance of ST59 in MRSA isolates in Anhui Province, China, in the 2020s [27]. Nevertheless, a study performed from 2009 to 2014 in a medical center in Southern Taiwan revealed that ST239 was the most common MLST type in hemodialysis cases (23.9%), followed by ST59 (17.7%) and ST45 (13.5%); however, infections by community-associated genotypes are increasing in the hemodialysis population [11]. In the present study, ST59 was the most predominant ST in the VAI MRSA population before and even during the pandemic and was especially prevalent in TCC-MRSA during the pandemic.…”

“…S. aureus carriers on hemodialysis have 1.8to 4.7-fold higher risk of vascular access infections (VAIs) and bacteremia compared with noncarriers [10]. The risk of MRSA infection in hemodialysis patients is 100 times that in the general population [11]. Patients receiving hemodialysis are highly susceptible to VAIs because of their long-term necessity for vascular access, frequent puncture of vascular access sites, repeated hospitalization, frequent and long-term use of antibiotics, and immunosuppression [12].…”

Susceptibility and molecular characterization of mec A- and mec B-positive community acquired methicillin-resistant Staphylococcus aureus isolates from students

“…MRSA infections are referred to as community acquired if there are no healthcare associated risks such as a recent hospitalisation or surgery, dialysis, residence in a long-term care facility, and the presence of a permanent indwelling catheter or percutaneous medical device at the time of culture [6,7]. There are increasing concerns over CA-MRSA as they cause outbreaks and are displacing nosocomial acquired MRSA as pathogens in infections [8,9]. Individuals can be carriers with no symptoms and CA-MRSA can be contracted from members of households or associations through shared facilities such as sports environment and equipment, swimming pools, clothing, and towels.…”