Advertisement

Clinical and molecular epidemiology of nursing home–associated Staphylococcus aureus bacteremia

  • Alan J. Lesse
    Correspondence
    Address correspondence to Alan J. Lesse, MD, 151 VAMC, 3495 Bailey Ave, Buffalo, NY 14215.
    Affiliations
    From the Departments of Medicine

    Microbiology

    Pharmacology and Tocicology School of Medicine and Biomedical Sciences University at Buffalo

    VA Western New York Healthcare Center
    Search for articles by this author
  • Joseph M. Mylotte
    Affiliations
    From the Departments of Medicine

    Pharmacology and Tocicology School of Medicine and Biomedical Sciences University at Buffalo

    Erie County Medical Center, Buffalo, NY
    Search for articles by this author

      Background and Objectives

      Although nursing home residents who have Staphylococcus aureus bacteremia (SAB) have been included in large studies of this infection, there are no published descriptions of SAB solely in nursing home residents. The objectives were to describe the clinical and molecular epidemiology of SAB in nursing home residents admitted to one hospital.

      Methods

      This was a retrospective review of hospital medical records of nursing home residents from 22 separate facilities who had SAB and were admitted to a specialty unit at one hospital from 1997 to 2003.

      Results

      For the seven-year study period, 39 episodes of SAB were identified; 15 were due to methicillin-susceptible S. aureus (MSSA) and 24 were due to methicillin-resistant S. aureus (MRSA). The incidence of SAB among all residents admitted to the specialty unit increased by more than eightfold primarily because of an increased incidence of bacteremia due to MRSA. The most common identified source was the urinary tract (18% of all episodes) but for 17 (44%) episodes, no focus was identified. Hospital mortality was 28% with all deaths occurring within 15 days of admission. Analysis of the MRSA strains by pulsed-field gel electrophoresis revealed that two pulsed-field types predominated when compared with the CDC national database: USA100- (N = 13) and USA 800-like strains (N = 7).

      Conclusions

      In the study population there was a substantial increase in incidence of SAB over a 7-year period due almost exclusively to an increased occurrence of MRSA. Hospital strains of MRSA predominated, as one would expect. Mortality was high but complications were low among survivors. These findings have important implications for choosing empiric antibiotic therapy in nursing home residents who have suspected S. aureus infection.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mylotte J.M.
        • Tayara A.
        • Goodnough S.
        Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes.
        Clin Infect Dis. 2002; 35: 1484-1490
        • McBean M.
        • Rajamani S.
        Increasing rates of hospitalization due to septicemia in the US elderly population, 1986-1997.
        J Infect Dis. 2001; 183: 596-603
        • Roghmann M.C.
        Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia.
        Arch Intern Med. 2000; 160: 1001-1004
        • Akram J.
        • Glatt A.E.
        True community-acquired methicillin-resistant Staphylococcus aureus bacteremia.
        Infect Control Hosp Epidemiol. 1998; 19: 106-107
        • Rezende N.A.
        • Blumberg H.M.
        • Metzger B.S.
        • Larsen N.M.
        • Ray S.M.
        • McGowan Jr., J.E.
        Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission.
        Am J Med Sci. 2002; 323: 117-123
        • Lodise Jr., T.P.
        • McKinnon P.S.
        • Rybak M.
        Prediction model to identify patients with Staphylococcus aureus bacteremia at risk for methicillin resistance.
        Infect Control Hosp Epidemiol. 2003; 24: 655-661
        • Johnson L.B.
        • Bhan A.
        • Pawlak J.
        • Manzor O.
        • Saravolatz L.D.
        Changing epidemiology of community-onset methicillin-resistant Staphylococcus aureus bacteremia.
        Infect Control Hosp Epidemiol. 2003; 24: 431-435
        • Knaus W.A.
        • Wagner D.P.
        • Draper E.A.
        • et al.
        The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults.
        Chest. 1991; 100: 1619-1636
        • Mylotte J.M.
        • Tayara A.
        Staphylococcus aureus bacteremia: predictors of 30-day mortality in a large cohort.
        Clin Infect Dis. 2000; 31: 1170-1174
        • Durack D.T.
        • Lukes A.S.
        • Bright D.K.
        New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service.
        Am J Med. 1994; 96: 200-209
        • Mylotte J.M.
        • McDermott C.
        Staphylococcus aureus bacteremia caused by infected intravenous catheters.
        Am J Infect Control. 1987; 15: 1-6
        • Chang F.Y.
        • Peacock Jr., J.E.
        • Musher D.M.
        • et al.
        Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study.
        Medicine. 2003; 82: 333-339
        • Harbarth S.
        • Rutschmann O.
        • Sudre P.
        • Pittet D.
        Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus.
        Arch Intern Med. 1998; 158: 182-189
        • Fowler Jr., V.G.
        • Olsen M.K.
        • Corey G.R.
        • et al.
        Clinical identifiers of complicated Staphylococcus aureus bacteremia.
        Arch Intern Med. 2003; 163: 2066-2072
        • McDougal L.K.
        • Steward C.D.
        • Killgore G.E.
        • Chaitram J.M.
        • McAllister S.K.
        • Tenover F.C.
        Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database.
        J Clin Microbiol. 2003; 41: 5113-5120
        • Murchan S.
        • Kaufmann M.E.
        • Deplano A.
        • et al.
        Harmonization of pulsed-field gel electrophoresis protocols for epidemiological typing of strains of methicillin-resistant Staphylococcus aureus: a single approach developed by consensus in 10 European laboratories and its application for tracing the spread of related strains.
        J Clin Microbiol. 2003; 41: 1574-1585
        • Oliveira D.C.
        • de Lencastre H.
        Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus.
        Antimicrob Agents Chemother. 2002; 46: 2155-2161
        • Lina G.
        • Piemont Y.
        • Godail-Gamot F.
        • et al.
        Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia.
        Clin Infect Dis. 1999; 29: 1128-1132
        • Fiebelkorn K.R.
        • Crawford S.A.
        • McElmeel M.L.
        • Jorgensen J.H.
        Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci.
        J Clin Microbiol. 2003; 41: 4740-4744
        • Yzerman E.P.
        • Boelens H.A.
        • Tjhie J.H.
        • Kluytmans J.A.
        • Mouton J.W.
        • Verbrugh H.A.
        Delta APACHE II for predicting course and outcome of nosocomial Staphylococcus aureus bacteremia and its relation to host defense.
        J Infect Dis. 1996; 173: 914-919
        • Mylotte J.M.
        • Aeschlimann J.R.
        • Rotella D.L.
        Staphylococcus aureus bacteremia: factors predicting hospital mortality.
        Infect Control Hosp Epidemiol. 1996; 17: 165-168
        • Drinka P.
        • Faulks J.T.
        • Gauerke C.
        • Goodman B.
        • Stemper M.
        • Reed K.
        Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home.
        Arch Intern Med. 2001; 161: 2371-2377
        • Mulhausen P.L.
        • Harrell L.J.
        • Weinberger M.
        • Kochersberger G.G.
        • Feussner J.R.
        Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes.
        Am J Med. 1996; 100: 24-31
        • von Eiff C.
        • Becker K.
        • Machka K.
        • Stammer H.
        • Peters G.
        Nasal carriage as a source of Staphylococcus aureus bacteremia: study group.
        N Engl J Med. 2001; 344: 11-16
        • Pujol M.
        • Pena C.
        • Pallares R.
        • et al.
        Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains.
        Am J Med. 1996; 100: 509-516
        • Muder R.R.
        • Brennen C.
        • Wagener M.M.
        • et al.
        Methicillin-resistant staphylococcal colonization and infection in a long-term care facility.
        Ann Intern Med. 1991; 114: 107-112
        • Bradley S.F.
        • Terpenning M.S.
        • Ramsey M.A.
        • et al.
        Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility.
        Ann Intern Med. 1991; 115: 417-422
        • Pacio G.A.
        • Visintainer P.
        • Maguire G.
        • Wormser G.P.
        • Raffalli J.
        • Montecalvo M.A.
        Natural history of colonization with vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilli among long-term-care facility residents.
        Infect Control Hosp Epidemiol. 2003; 24: 246-250
        • McClelland R.S.
        • Fowler Jr., V.G.
        • Sanders L.L.
        • et al.
        Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality.
        Arch Intern Med. 1999; 159: 1244-1247
        • Soriano A.
        • Martinez J.A.
        • Mensa J.
        • et al.
        Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia.
        Clin Infect Dis. 2000; 30: 368-373
        • Jensen A.G.
        • Wachmann C.H.
        • Espersen F.
        • Scheibel J.
        • Skinhoj P.
        • Frimodt-Moller N.
        Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases.
        Arch Intern Med. 2002; 162: 25-32
        • Blyth C.C.
        • Darragh H.
        • Whelan A.
        • O'Shea J.P.
        • Beaman M.H.
        • McCarthy J.S.
        Evaluation of clinical guidelines for the management of Staphylococcus aureus bacteraemia.
        Intern Med J. 2002; 32: 224-232
        • Verhagen D.W.
        • van der Meer J.T.
        • Hamming T.
        • de Jong M.D.
        • Speelman P.
        Management of patients with Staphylococcus aureus bacteraemia in a university hospital: a retrospective study.
        Scand J Infect Dis. 2003; 35: 459-463
        • Lesens O.
        • Methlin C.
        • Hansmann Y.
        • et al.
        Role of comorbidity in mortality related to Staphylococcus aureus bacteremia: a prospective study using the Charlson weighted index of comorbidity.
        Infect Control Hosp Epidemiol. 2003; 24: 890-896
        • Cosgrove S.E.
        • Sakoulas G.
        • Perencevich E.N.
        • Schwaber M.J.
        • Karchmer A.W.
        • Carmeli Y.
        Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.
        Clin Infect Dis. 2003; 36: 53-59
        • Romero-Vivas J.
        • Rubio M.
        • Fernandez C.
        • Picazo J.J.
        Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus.
        Clin Infect Dis. 1995; 21: 1417-1423
        • Lodise T.P.
        • McKinnon P.S.
        • Swiderski L.
        • Rybak M.J.
        Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia.
        Clin Infect Dis. 2003; 36: 1418-1423
        • Kuehnert M.J.
        • Kruszon-Moran D.
        • Hill H.A.
        • et al.
        Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002.
        J Infect Dis. 2006; 193: 172-179
        • Francis J.S.
        • Doherty M.C.
        • Lopatin U.
        • et al.
        Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes.
        Clin Infect Dis. 2005; 40: 100-107
        • Carleton H.A.
        • Diep B.A.
        • Charlebois E.D.
        • Sensabaugh G.F.
        • Perdreau-Remington F.
        Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA.
        J Infect Dis. 2004; 190: 1730-1738