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Emergence of Community‐Associated Methicillin‐Resistant Staphylococcus aureus Strains as a Cause of Healthcare‐Associated Bloodstream Infections in Korea

Sun Hee Park , MD, Chulmin Park , PhD, Jin‐Hong Yoo , MD, Su‐Mi Choi , MD, Jung‐Hyun Choi , MD, Hyun‐Ho Shin, Dong‐Gun Lee , MD, Seungok Lee , MD, JaYoung Kim , MD, So Eun Choi , RN, MS, Young‐Mi Kwon , RN, MS and Wan‐Shik Shin , MD
Infection Control and Hospital Epidemiology
Vol. 30, No. 2 (February 2009), pp. 146-155
DOI: 10.1086/593953
Stable URL: http://www.jstor.org/stable/10.1086/593953
Page Count: 10
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Emergence of Community‐Associated Methicillin‐Resistant Staphylococcus aureus Strains as a Cause of Healthcare‐Associated Bloodstream Infections in Korea
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Abstract

Background.  The prevalence of community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) strains causing bloodstream infection (BSI) has not been studied in Korea. Objective.  We sought to determine the prevalence of CA‐MRSA strains among isolates recovered from patients with MRSA BSIs and to explore epidemiological changes in Korea. We also sought to evaluate clinical characteristics relevant to the development of healthcare‐associated BSIs. Methods.  We prospectively collected consecutive MRSA isolates from patients with BSI at 4 hospitals from July 1 through November 30, 2007, and we also included MRSA isolates recovered from culture of blood samples collected during a previous year (October 1, 2004 through September 30, 2005) at a different hospital. Molecular typing studies were performed, including pulsed‐field gel electrophoresis (PFGE), multilocus sequence typing, Staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. We compared the clinical characteristics and outcomes of patients with healthcare‐associated BSI due to CA‐MRSA strains with those of patients with healthcare‐associated BSI due to healthcare‐associated MRSA (HA‐MRSA) strains. Results.  There were 76 cases of MRSA BSI, of which 4 (5.3%) were community‐associated and 72 (94.7%) were healthcare‐associated. Among the 72 HA‐MRSA BSIs, 18 (25%) were community onset, and 54 (75%) were hospital onset. PFGE type D‐ST72–spa B–SCCmec type IVA MRSA, the predominant genotype of CA‐MRSA in Korea, accounted for 19 (25%) of all 76 MRSA BSIs, including 17 (23.6%) of 72 HA‐MRSA BSIs and 11 (20.8%) of 53 hospital‐onset HA‐MRSA BSIs. Patients with healthcare‐associated BSIs due to CA‐MRSA strains carrying SCCmec type IVA tended to have fewer healthcare‐associated risk factors, compared with patients with healthcare‐associated BSIs due to HA‐MRSA strains carrying other SCCmec types. The presence of a central venous catheter or other invasive device was the only independent factor differentiating patients infected with hospital‐associated genotype strains from patients infected with other strains. Clinical outcomes were similar between both groups. Conclusions.  CA‐MRSA strains are emerging as a major cause of BSI in healthcare settings in Korea. This changing epidemiology of MRSA poses a challenge to public health and infection control in hospital settings.

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