Clinical and molecular epidemiology of meticillin-resistant Staphylococcus aureus causing bacteraemia in Southern Spain

Summary Background Some molecular features of meticillin-resistant Staphylococcus aureus (MRSA) isolates causing invasive infections have been shown to have clinical implications. There is a need to monitor the situation using a combination of molecular and clinical data because, although MRSA clone...

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Bibliographic Details
Published in:The Journal of hospital infection 2012-08, Vol.81 (4), p.257-263
Main Authors: Velasco, C, López-Cortés, L.E, Caballero, F.J, Lepe, J.A, de Cueto, M, Molina, J, Rodríguez, F, Aller, A.I, García Tapia, A.M, Pachón, J, Pascual, Á, Rodríguez-Baño, J
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antimicrobial resistance
Bacteremia - epidemiology
Bacteremia - microbiology
Bloodstream infections
Cluster Analysis
Cohort Studies
DNA, Bacterial - genetics
Electrophoresis, Gel, Pulsed-Field
Female
Humans
Infectious Disease
Male
Methicillin-Resistant Staphylococcus aureus - classification
Methicillin-Resistant Staphylococcus aureus - genetics
Methicillin-Resistant Staphylococcus aureus - isolation & purification
Meticillin resistance
Microbial Sensitivity Tests
Molecular Epidemiology
Molecular Typing
Retrospective Studies
Spain - epidemiology
Staphylococcal Infections - epidemiology
Staphylococcal Infections - microbiology
Staphylococcus aureus
Vancomycin - pharmacology
Vancomycin Resistance
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Summary:Summary Background Some molecular features of meticillin-resistant Staphylococcus aureus (MRSA) isolates causing invasive infections have been shown to have clinical implications. There is a need to monitor the situation using a combination of molecular and clinical data because, although MRSA clones tend to predominate over wide geographical areas, clonal shifts may take place. Aim To study the epidemiological features and perform molecular characterization of a retrospective cohort of 98 cases of nosocomial and healthcare-associated MRSA bacteraemia in 10 hospitals in Andalusia, Spain. Methods Relatedness of isolates was investigated using pulsed-field gel electrophoresis (PFGE), S. aureus protein A ( spa ) typing and clonal complex (CC) assignment. Staphylococcal chromosomal cassette mec (SCC mec ) type and accessory gene regulator ( agr ) group were studied by polymerase chain reaction. agr function was assessed. Results Most isolates were CC5, SCC mec type IV and agr group II. The most common spa type was t067. Six major clusters were identified by PFGE. Six small clusters of epidemiologically related cases sharing isolates from the same PFGE subtype were identified. Five percent of isolates had a vancomycin minimum inhibitory concentration (MIC) of 2 μg/mL on broth microdilution, although 44% had an MIC >1 μg/mL on E-test. Variables independently associated with MIC >1 mg/L on E-test were surgery during present admission and Charlson index ≥2. Conclusion A specific CC that has been predominant in Spain over the last decade caused most of the cases in this study. PFGE was more discriminatory than spa typing in showing clusters of epidemiologically related cases. Some patient features were associated with vancomycin MIC >1 mg/L on E-test.
ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2012.05.007