Lack of association between genotypes and haematogenous seeding infections in a large cohort of patients with methicillin-resistant Staphylococcus aureus bacteraemia from 21 Spanish hospitals

Authors

  • O. Gasch,

    Corresponding author
    1. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
    • Corresponding author: O. Gasch, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907, Barcelona, Spain

      E-mail: ogasch@bellvitgehospital.cat

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  • M. Camoez,

    1. Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
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  • M. A. Dominguez,

    1. Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
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  • B. Padilla,

    1. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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  • V. Pintado,

    1. Department of Infectious Diseases, Hospital Ramon Y Cajal, Madrid, Spain
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  • B. Almirante,

    1. Department of Infectious Diseases, Hospital Vall d'Hebrón, Barcelona, Spain
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  • C. Martín-Gandul,

    1. Department of Infectious Diseases, Hospital Virgen del Rocío, Sevilla, Spain
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  • F. López-Medrano,

    1. Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
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  • E. Ruiz de Gopegui,

    1. Department of Microbiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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  • J. Ramón Blanco,

    1. Department of Infectious Diseases, Hospital San Pedro, Logroño, Spain
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  • G. García-Pardo,

    1. Preventive Medicine Unit, University Hospital Joan XXIII, Tarragona, Spain
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  • E. Calbo,

    1. Department of Infectious Diseases, Hospital Mútua, Terrassa, Spain
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  • J. P. Horcajada,

    1. Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain
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  • A. Granados,

    1. Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Spain
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  • A. Jover-Sáenz,

    1. Department of Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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  • C. Dueñas,

    1. Department of Medicine, Hospital de Burgos, Burgos, Spain
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  • M. Pujol,

    1. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
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  • and on behalf of REIPI/GEIM Study Groups

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    • REIPI/GEIH Study Groups: A. Jover, F. Barcenilla, M. Garcia (H Arnau de Vilanova, Lleida, Spain); M. Pujol, O. Gasch, Ma.A. Domínguez, M. Camoez (H Bellvitge, Universitat de Barcelona, IDIBELL, Barcelona, Spain); C. Dueñas, E. Ojeda (H. Burgos, Burgos, Spain); J. A. Martinez, F. Marco (H Clinic, Barcelona, Spain); F. Chaves, M. Lagarde, F. López-Medrano (HU 12 de Octubre, Madrid, Spain); J. M. Montejo, E. Bereciartua, J. L. Hernández (H de Cruces, Bilbao, Spain); M. Á. Von Wichmann, A. Goenaga, J. M. García-Arenzana (H Donostia, Donostia, Spain); B. Padilla, C. Padilla, E. Cercenado (HGU Gregorio Marañón, Madrid, Spain); G. García-Pardo, J. Tapiol (HU Joan XXIII, Tarragona, Spain); J. P. Horcajada, M. Montero, M. Salvadó (HU del Mar, Barcelona, Spain); A. Arnáiz, C. Fernandez (HU Marques de Valdecilla, Santander, Spain); E. Calbo, M. Xercavins (HU Mutua de Terrassa, Terrassa, Spain); A. Granados, D. Fontanals (H del Parc Taulí, Sabadell, Spain); V. Pintado, E. Loza (HU Ramon y Cajal, Madrid, Spain); J. Torre-Cisneros, R. Lara, F. Rodríguez-López, M. Rodríguez, C. Natera (HU Reina Sofía, Córdoba, Spain); J. R. Blanco, I. Olarte (H San Pedro de la Rioja, Logroño, Spain); N. Benito, B. Mirelis (H de la Santa Creu i Sant Pau, Barcelona, Spain); J. Murillas, E. Ruiz de Gopegui (HU Son Espases, Mallorca, Spain); H. Espejo, Ma. A. Morera (H de Terrassa, Terrassa, Spain); J. Rodróguez-Baño, E. López, A. Pascual (HU Virgen Macarena, Sevilla, Spain); C. Martin, J. A. Lepe, J. Molina (HU Virgen del Rocio, Sevilla, Spain); R. Sordé, B. Almirante, N. Larrosa (HU Vall d'Hebrón, Barcelona, Spain).

Abstract

There is increasing concern regarding the association between certain methicillin-resistant Staphylococcus aureus (MRSA) genotypes and poor clinical outcome. To assess this issue, a large cohort of 579 subjects with MRSA bacteraemia was prospectively followed from June 2008 to December 2009, in 21 hospitals in Spain. Epidemiology, clinical data, therapy, and outcome were recorded. All MRSA strains were analysed in a central laboratory. Presence of a haematogenous seeding infection was the dependent variable in an adjusted logistic regression model. Of the 579 patients included in the study, 84 (15%) had haematogenous seeding infections. Microdilution vancomycin median MIC (IQR) was 0.73 (0.38–3) mg/L. Most MRSA isolates (n = 371; 67%) belonged to Clonal Complex 5 (CC5) and carried an SCCmec element type IV and agr type 2. Isolates belonging to ST8-agr1-SCCmecIV, ST22-agr1-SCCmecIV and ST228-agr2-SCCmecI—a single locus variant of ST5—accounted for 8%, 9% and 9% of the isolates, respectively. After adjusting by clinical variables, any of the clones was associated with increased risk of haematogenous seeding infections. Higher vancomycin MIC was not identified as an independent risk factor, either. In contrast, persistent bacteraemia (OR 4.2; 2.3–7.8) and non-nosocomial acquisition (3.0; 1.7–5.6) were associated with increased risk.

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