TY - JOUR
T1 - Community-Associated Strains of Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus in Indigenous Northern Australia
T2 - Epidemiology and Outcomes
AU - TONG, S
AU - BISHOP, E
AU - Gorie, Rachael
AU - CHENG, A
AU - SPASOVA-PENKOVA, Z
AU - Holt, Deborah
AU - Giffard, Philip
AU - McDonald, Malcolm
AU - Currie, Bart
AU - BOUTLIS, C
PY - 2009
Y1 - 2009
N2 - Background. Some strains of non-multidrug-resistant, methicillin-resistant Staphylococcus aureus (nmMRSA) in Australia are likely to have emerged from strains of methicillin-susceptible S. aureus (MSSA) in remote Aboriginal communities. Objective. To describe the clinical epidemiology of infection due to community-associated MRSA strains in an Australian tropical hospital setting with a significant Aboriginal population and to compare infections caused by community-associated strains of MRSA, health-care-associated strains of MRSA, and MSSA strains with respect to demographic risk factors and clinical outcomes. Methods. We queried the microbiology database for the Top End of the Northern Territory, Australia, to determine population incidences for S. aureus infection and conducted a prospective matched case-control study to compare infection due to nmMRSA, MSSA, or multidrug-resistant MRSA at the Royal Darwin Hospital. Results. The annual incidence of S. aureus bacteremia was 65 cases per 100,000 population, but in the Aboriginal population the incidence was 172 cases per 100,000 population (odds ratio [OR] compared with non-Aboriginal population, 5.8 [95% confidence interval {CI}, 3.8-8.9). Female sex (adjusted OR [aOR], 1.5 [95% CI, 1.1-2.0) and remote residence (aOR, 1.8 [95% CI, 1.2-2.5]) were associated with the isolation of nmMRSA rather than MSSA, but disease spectrum and outcomes were similar. Among those from whom nmMRSA was isolated, Aboriginal patients were younger (aOR for each additional year, 0.94 [95% CI, 0.92-0.96]), more likely to be female (aOR, 3.8 [95% CI, 1.7-8.5]), and more likely to reside in a remote community (aOR, 29 [95% CI, 8.9-94]) than non-Aboriginal patients. The presence of Panton-Valentine leukocidin in nmMRSA was associated with double the odds of sepsis (aOR, 2.2 [95% CI, 1.1-4.6]). Conclusions. The association of nmMRSA infection with female sex and remote residence supports the hypothesis that nmMRSA arose from MSSA strains in remote Aboriginal communities where staphylococcal disease is highly prevalent. The similar clinical spectrum and outcomes for nmMRSA infection and MSSA infection suggest that virulence is not correlated with resistance phenotype. � 2009 by the Infectious Diseases Society of America.
AB - Background. Some strains of non-multidrug-resistant, methicillin-resistant Staphylococcus aureus (nmMRSA) in Australia are likely to have emerged from strains of methicillin-susceptible S. aureus (MSSA) in remote Aboriginal communities. Objective. To describe the clinical epidemiology of infection due to community-associated MRSA strains in an Australian tropical hospital setting with a significant Aboriginal population and to compare infections caused by community-associated strains of MRSA, health-care-associated strains of MRSA, and MSSA strains with respect to demographic risk factors and clinical outcomes. Methods. We queried the microbiology database for the Top End of the Northern Territory, Australia, to determine population incidences for S. aureus infection and conducted a prospective matched case-control study to compare infection due to nmMRSA, MSSA, or multidrug-resistant MRSA at the Royal Darwin Hospital. Results. The annual incidence of S. aureus bacteremia was 65 cases per 100,000 population, but in the Aboriginal population the incidence was 172 cases per 100,000 population (odds ratio [OR] compared with non-Aboriginal population, 5.8 [95% confidence interval {CI}, 3.8-8.9). Female sex (adjusted OR [aOR], 1.5 [95% CI, 1.1-2.0) and remote residence (aOR, 1.8 [95% CI, 1.2-2.5]) were associated with the isolation of nmMRSA rather than MSSA, but disease spectrum and outcomes were similar. Among those from whom nmMRSA was isolated, Aboriginal patients were younger (aOR for each additional year, 0.94 [95% CI, 0.92-0.96]), more likely to be female (aOR, 3.8 [95% CI, 1.7-8.5]), and more likely to reside in a remote community (aOR, 29 [95% CI, 8.9-94]) than non-Aboriginal patients. The presence of Panton-Valentine leukocidin in nmMRSA was associated with double the odds of sepsis (aOR, 2.2 [95% CI, 1.1-4.6]). Conclusions. The association of nmMRSA infection with female sex and remote residence supports the hypothesis that nmMRSA arose from MSSA strains in remote Aboriginal communities where staphylococcal disease is highly prevalent. The similar clinical spectrum and outcomes for nmMRSA infection and MSSA infection suggest that virulence is not correlated with resistance phenotype. � 2009 by the Infectious Diseases Society of America.
KW - cotrimoxazole
KW - fusidic acid
KW - Panton Valentine leukocidin
KW - rifampicin
KW - tetracycline
KW - vancomycin
KW - Aborigine
KW - adult
KW - age distribution
KW - antibiotic sensitivity
KW - article
KW - Australia
KW - bacterial strain
KW - bacterium isolate
KW - case control study
KW - controlled study
KW - demography
KW - epidemiological data
KW - female
KW - geographic distribution
KW - human
KW - incidence
KW - indigenous people
KW - infection risk
KW - major clinical study
KW - male
KW - methicillin resistant Staphylococcus aureus
KW - methicillin resistant Staphylococcus aureus infection
KW - methicillin susceptible Staphylococcus aureus
KW - multidrug resistance
KW - priority journal
KW - sex difference
KW - staphylococcal bacteremia
KW - Staphylococcus aureus
KW - Adult
KW - Community-Acquired Infections
KW - Comorbidity
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Methicillin-Resistant Staphylococcus aureus
KW - Middle Aged
KW - Multivariate Analysis
KW - Northern Territory
KW - Oceanic Ancestry Group
KW - Patient Selection
KW - Prospective Studies
KW - Risk Factors
KW - Seasons
KW - Streptococcal Infections
UR - http://www.scopus.com/inward/record.url?scp=65549090640&partnerID=8YFLogxK
M3 - Article
VL - 199
SP - 1461
EP - 1470
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 10
ER -