Comparative evaluation of epidemiology and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) USA300 infections causing community- and healthcare-associated infections

Moore, Carol L.; Hingwe, Ameet; Donabedian, Susan; Perri, Mary Beth; Davis, Susan L.; Haque, Nadia Z.; Reyes, Katherine; Vager, Dora; Zervos, Marcus J.

doi:10.1016/j.ijantimicag.2009.03.004

Cited by 54 publications

(42 citation statements)

References 36 publications

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“…Recent studies have documented the considerable presence of USA300 in the health care setting, and the emergence of resistance to other antimicrobials in USA300 MRSA was recently reported, with investigators suggesting horizontal plasmid transfer from nosocomial USA100 MRSA isolates (22,32). Previous work by the current investigators has demonstrated higher clinical failure rates in the treatment of USA300 MRSA infections when a health care association was present compared to communityassociated disease (25). The results from this study highlight an important relationship and perhaps an emerging pattern of concern in the epidemiology of USA300 MRSA.…”

Section: Discussionmentioning

confidence: 68%

Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool

Moore

Lü

Cheema

et al. 2011

Antimicrob Agents Chemother

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Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of bloodstream infection (BSI)and is often associated with invasive infections and high rates of mortality. Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported. We conducted a comprehensive evaluation of the factors (patient, strain, infection, and treatment) involved in the etiology and management of MRSA BSI to create a risk stratification tool for clinicians. This study included consecutive patients with MRSA BSI treated with vancomycin over 2 years in an inner-city hospital in Detroit, MI. Classification and regression tree analysis (CART) was used to develop a risk prediction model that characterized vancomycin-treated patients at high risk of clinical failure. Of all factors, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, with a cutoff point of 14, was found to be the strongest predictor of failure and was used to split the population into two groups. Forty-seven percent of the population had an APACHE-II score < 14, a value that was associated with low rates of clinical failure (11%) and mortality (4%). Fifty-four percent of the population had an APACHE-II score > 14, which was associated with high rates of clinical failure (35%) and mortality (23%). The risk stratification model identified the interplay of three other predictors of failure, including the vancomycin MIC as determined by Vitek 2 analysis, the risk level of the source of BSI, and the USA300 strain type. This model can be a useful tool for clinicians to predict the likelihood of success or failure in vancomycin-treated patients with MRSA bloodstream infection.Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of bloodstream infection (BSI) and has been associated with mortality rates of between 20 and 30% (16,18,24,30,33). Invasive infections caused by MRSA have been implicated in over 18,000 deaths annually (14). Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported (3,7,24). There is also growing evidence that infection with an organism with an increased vancomycin MIC that is still within the susceptible range may also be associated with increased rates of vancomycin failure (9,23,29,30). Evidence suggests that the increased risk associated with a vancomycin MIC of 2 g/ml is not mitigated by targeting higher vancomycin trough concentrations in the range of 15 to 20 g/ml (9). It has been postulated that strategies such as increasing the vancomycin trough concentration or the area under the curve (AUC)/MIC ratio may theoretically be associated with better outcomes in MRSA BSI; however, this has yet to be proven in prospective clinical trials (27).Given the emerging information relating to outcomes of vancomycin treatment in cases of MRSA BSI, a comprehensive evaluati...

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Section: Discussionmentioning

confidence: 68%

Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool

Moore

Lü

Cheema

et al. 2011

Antimicrob Agents Chemother

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“…S. aureus is an evolving management challenge for two main reasons: (i) the increasing prevalence of MRSA as the principal pathogen in surgical site infections [7]; and (ii) the growing importance of communityassociated MRSA and its contribution to healthcare-acquired infection, including necrotising fasciitis and myositis [8]. There is an increasing amount of in vitro as well as clinical evidence to support the antimicrobial treatment of such infections with daptomycin [9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibility of Gram-positive cocci isolated from skin and skin-structure infections in European medical centres

Sader

Farrell

Jones

2010

International Journal of Antimicrobial Agents

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“…Our goal was to determine bacterial and epithelial responses that follow early interactions between the alveolar wall and USA300, with an eye to understanding the time course of bacterial stabilization and subsequent epithelial injury. We also addressed the puzzling feature of this pathology that although USA300 might be antibiotic sensitive in vitro (22,23), antibiotics tend to be ineffective in containing lung injury (23)(24)(25), possibly because of host factors.…”

Section: Introductionmentioning

confidence: 99%

Disruption of staphylococcal aggregation protects against lethal lung injury

Hook

Islam

Parker

et al. 2018

Journal of Clinical Investigation

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Comparative evaluation of epidemiology and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) USA300 infections causing community- and healthcare-associated infections

Cited by 54 publications

References 36 publications

Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool

Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool

Antimicrobial susceptibility of Gram-positive cocci isolated from skin and skin-structure infections in European medical centres

Disruption of staphylococcal aggregation protects against lethal lung injury

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