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Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study

Wehrhahn, M.C., Robinson, J.O., Pearson, J.C., O’Brien, F.G., Tan, H.L., Coombs, G.W.ORCID: 0000-0003-1635-6506, Pascoe, E.M., Lee, R., Salvaris, P., Salvaris, R., New, D. and Murray, R.J. (2010) Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study. European Journal of Clinical Microbiology & Infectious Diseases, 29 (8). pp. 1025-1033.

Link to Published Version: http://dx.doi.org/10.1007/s10096-010-0973-4
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Abstract

Differences between the features of invasive community-onset methicillin-resistant Staphylococcus aureus (cMRSA) and methicillin-susceptible S. aureus (cMSSA) infections are incompletely understood. Fifty-seven patients with invasive cMRSA infection were prospectively identified at two teaching hospitals; for each cMRSA case, two cases of invasive cMSSA infection acted as controls. The primary outcome was 30-day all-cause mortality. Patients with invasive cMRSA infection were more likely to be Aboriginal (25% vs. 14%, age-adjusted odds ratio [OR] 2.5, p=0.037), reside in a long-term care facility and/or have been hospitalised in the previous year (51% vs. 34%, p=0.04) and less likely to have endocarditis (2% vs. 12%, p=0.02) or require admission to an intensive care unit or high-dependency area (7% vs. 21%, p=0.02). All-cause mortality at 30 days was similar in the cMRSA and cMSSA groups (9% vs. 7%, p=0.68). Panton-Valentine leukocidin (PVL) genes were detected in a similar proportion of cMRSA and cMSSA isolates (32% vs. 27%, p=0.49) and the presence of PVL genes was associated with younger age (35 years vs. 55 years, p<0.001), Aboriginal ethnicity (38% vs. 10%, p<0.001), skin and soft-tissue infection (54% vs. 19%, p<0.001), lower illness severity at presentation (SAPS II score 9 vs. 21, p=0.001) and shorter hospitalisation (9 days vs. 24 days, p<0.001). Patients with "PVL-positive" and "PVL-negative" S. aureus infection had similar 30-day all-cause mortality (4% vs. 9%, p=0.28). Few clinical features differentiated patients with invasive cMRSA infection from those with infection caused by cMSSA. Invasive "PVL-positive" S. aureus infection was associated with less morbidity but similar mortality to "PVL-negative" infection.

Item Type: Journal Article
Publisher: Springer Verlag
Copyright: © 2010 Springer-Verlag.
URI: http://researchrepository.murdoch.edu.au/id/eprint/30773
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