Staphylococcal Enterotoxin P Predicts Bacteremia in Hospitalized Patients Colonized With Methicillin-Resistant Staphylococcus aureus

Calderwood, Michael S.; Desjardins, Christopher A.; Sakoulas, George; Nicol, Robert; DuBois, Andrea M.; Delaney, Mary L.; Kleinman, Ken; Cosimi, Lisa A.; Feldgarden, Michael; Onderdonk, Andrew B.; Birren, Bruce W.; Platt, Richard; Huang, Susan S.

doi:10.1093/infdis/jit501

Cited by 29 publications

(23 citation statements)

References 47 publications

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“…It is unknown if patients with HAHO-MRSA were colonized with the MRSA strain prior to their hospitalization, or if MRSA was acquired in the hospital. It has been reported that patients are more likely to develop infection if they are colonized (27), but it also has been shown that despite colonization, some strains may be less likely to cause invasive disease (28).…”

Section: Discussionmentioning

confidence: 99%

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

et al. 2015

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Historically, HA-MRSA and CA-MRSA could be clearly distinguished by clinical characteristics, antibiotic resistance patterns, and molecular typing (2). Well-described HA-MRSA risk factors for infection include a history of hospitalization, intravenous catheters, previous MRSA infections, residence in a long-termcare facility (LTCF), or surgery (3). CA-MRSA strains were detected mostly in younger patients, often associated with skin and soft-tissue infections, and tended to be less resistant to non-␤-lactam antibiotics (2). In the United States, the major genotype for HA-MRSA is pulsed-field gel electrophoresis (PFGE) USA100, clonal complex 5 (CC5), and staphylococcal cassette chromosome mec type II (SCCmec II), and for CA-MRSA the major genotype is PFGE USA300, CC8, and SCCmec IV (4). Recently, genotyping studies have shown that traditional CA-MRSA strains are increasingly associated with infections in hospitals, and conversely, traditional HA-MRSA strains have been reported in community patients with no HA risk factors (2,5,6). Genotyping studies also have shown that certain strains of S. aureus may be more likely to cause invasive infections or bacteremia than colonization (7).Since 2005, the Emerging Infection Program-Active Bacterial Core surveillance system (EIP-ABCs) of the Centers for Disease Control and Prevention (CDC) has been tracking MRSA infections in 9 U.S. cities and estimating the national burden of invasive MRSA infections (8, 9). From 2005 to 2011, the total number of MRSA invasive infections has decreased, but the proportion of community onset infections has increased since 2011 (8). Of the estimated 80,461 invasive MRSA infections that occurred in the United States in 2011, 18% were HAHO-MRSA, 60% were HACO-MRSA, and 21% were CA-MRSA (8, 10). MRSA bloodstream infection (BSI) has been the largest category of invasive MRSA disease, comprising 80% of the infections in 2011 (7,8,10).As described above, distinct clinical and molecular differences between HA-MRSA and CA-MRSA BSI have been shown, but very little is known regarding differences between HAHO-and HACO-MRSA BSI. Several important questions arise. Are there distinct clinical features that differentiate between MRSA BSI strains associated with HAHO-and HACO-MRSA cases not previously recognized, and are these clinical traits due to distinct

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Section: Discussionmentioning

confidence: 99%

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

et al. 2015

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“…59 Beyond antibiotic resistance and the presence of specific virulence factors, clonal associations of organisms have been shown to be useful in predicting outcomes. 60 In conclusion, these results for S. aureus colonization show that the isolates likely came from a single strain, as determined by spa typing. The prevalence of S. aureus colonization was relatively consistent in both SA3Ag and placebo recipients throughout the 12-month study period.…”

Section: Anatomical Sitementioning

confidence: 57%

S. aureus colonization in healthy Australian adults receiving an investigational S. aureus 3-antigen vaccine

Marshall

Richmond

Nissen

et al. 2019

Journal of Infection

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Objectives: Assess Staphylococcus aureus (S. aureus) colonization in healthy Australian adults receiving an investigational S. aureus 3-antigen vaccine (SA3Ag). Methods: In this phase 1, double-blind, sponsor-unblinded study, participants were randomized to receive a single dose (1 of 3 dose levels) of SA3Ag or placebo and a booster dose or placebo at 6 months. S. aureus isolates from nasal, perineal, and oropharyngeal swabs before and through 12 months post-vaccination were identified. Results: Baseline S. aureus colonization prevalence was 30.6% (any site), with nasal carriage (27.0%) more common than oropharyngeal/perineal (3.2% each). Following initial vaccination (low-dose: 102; mid-dose: 101; high-dose: 101; placebo: 102) and booster (low-dose: 45; mid-dose: 44; high-dose: 27; placebo: 181), placebo and SA3Ag groups showed similar S. aureus carriage through 12 months. Most colonized participants (74.0%) were colonized by single spa types. Placebo and SA3Ag groups had similar persistence of colonization, with 19.6-30.7% due to single spa types. Acquisition was observed in mid-and highdose recipients (∼20%) and low-dose and placebo recipients (∼12%). Vaccination resulted in substantial increases in antibodies to all 3 antigens, irrespective of carriage status. Conclusions: Based on descriptive analyses of this small study, SA3Ag vaccination did not impact S. aureus acquisition or carriage. Carriage status did not impact antibody responses to SA3Ag.

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“…mortality in patients with SAB in several studies (9)(10)(11)(12). In turn, the presence of SAB also indicated an increased risk of death in cancer patients (13,14).…”

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confidence: 95%

Prevalence, predictors, and mortality of bloodstream infections due to methicillin-resistant Staphylococcus aureus in patients with malignancy: systemic review and meta-analysis

Zhuang

Wang

et al. 2020

Preprint

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Background: This systemic review was performed to estimate the global methicillin-resistant Staphylococcus aureus (MRSA) prevalence among bacteremia in patients with malignancy, and further study the predictors and mortality of cancer patients with MRSA bacteremia. Methods: The PubMed and EMBASE databases were searched for studies published from Jan. 2000 to Mar. 2020. A random-effects model meta-analysis was performed to estimate the pooled prevalence of MRSA with 95% confidence intervals (95% CIs).Results: The pooled prevalence of MRSA was 3% (95% CI 2–5%) among all bloodstream infections (BSIs) and 44% (95% CI 32–57%) among S. aureus bacteremia in cancer patients. Based on geographical stratification, the pooled prevalence was 5% in Africa (95% CI 1–14%), 1% in Americas (95% CI 1–2%), 2% in Europe (95% CI 1–4%), 4% in Western Pacific (95% CI 2–7%), 8% in South-east Asia (95% CI 4–14%) and 0% in Eastern Mediterranean (95% CI 0–3%). No significant temporal change in MRSA rates was detected in this analysis (R2 = 0.06; P=0.24). Predictors for MRSA BSIs among cancer patients were identified by comparison with their methicillin-susceptible counterparts, and they were mainly related to healthcare-associated infections and immunosuppression. Finally, the 60-day mortality in adult cancer patients with MRSA BSIs was reported to be 12%, and the 6-month overall mortality was 43.2%, with community-onset infection, secondary BSI, and vancomycin MIC≥2g/mL being the risk factors for mortality.Conclusions: Although the prevalence of MRSA BSIs among cancer patients is relatively low, it did not decline over time as MRSA BSIs in the general hospital population and the high mortality rate was related to MRSA BSIs in patients with malignancy.

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Staphylococcal Enterotoxin P Predicts Bacteremia in Hospitalized Patients Colonized With Methicillin-Resistant Staphylococcus aureus

Abstract: In an analysis controlling for host factors, colonization with MRSA carrying sep increased the risk of MRSA bacteremia. Identification of risk-adjusted genetic determinants of virulence may help to improve prediction of invasive disease and suggest new targets for therapeutic intervention.

Cited by 29 publications

References 47 publications

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

Molecular and Clinical Characteristics of Hospital and Community Onset Methicillin-Resistant Staphylococcus aureus Strains Associated with Bloodstream Infections

S. aureus colonization in healthy Australian adults receiving an investigational S. aureus 3-antigen vaccine

Prevalence, predictors, and mortality of bloodstream infections due to methicillin-resistant Staphylococcus aureus in patients with malignancy: systemic review and meta-analysis

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