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Volume 18, Number 10—October 2012

CME ACTIVITY

Methicillin-Resistant Staphylococcus aureus Sequence Type 239-III, Ohio, USA, 2007–20091

Shu-Hua WangComments to Author , Yosef Khan, Lisa Hines, José R. Mediavilla, Liangfen Zhang, Liang Chen, Armando Hoet, Tammy Bannerman, Preeti Pancholi, D. Ashley Robinson, Barry N. Kreiswirth, Kurt B. Stevenson, and for the Prevention Epicenter Program of the Centers for Disease Control and Prevention
Author affiliations: The Ohio State University Wexner Medical Center, Columbus, Ohio, USA (S.H. Wang, Y. Khan, L. Hines, A. Hoet, P. Pancholi, K.B. Stevenson); University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA (J.R. Mediavilla, L. Chen, B.N. Kreiswirth); University of Mississippi Medical Center, Jackson, Mississippi, USA (L. Zhang, D.A. Robinson); and The Ohio Department of Health Laboratories, Reynoldsburg, Ohio, USA (T. Bannerman)

Main Article

Table

Characteristics of 1,286 patients with MRSA ST239-III and non–MRSA ST239-III infections, Ohio, USA, 2007–2009*

Characteristic ST239, n = 78 USA100, n = 481 p value USA300, n = 574 p value All other, n = 153 p value
Outreach hospital isolates 7 (9) 81 (17) NA 262 (46) NA 47 (31) NA
Patient demographics

Mean age, y (range)

58 (19–90) 61 (18–99) 0.06 43 (18–92) <0.0001 49 (18–94) 0.001

Male sex

46 (59) 259 (54) 0.39 311 (54) 0.42 80 (52) 0.33

White race

65 (83) 393 (82) 0.85 441 (77) 0.61 126 (82) 0.77
Medical history

Diabetes

33 (42) 149 (31) 0.047 116 (20) <0.0001 35 (23) 0.002

Chronic lung disease

26 (33) 117 (24) 0.09 74 (13) <0.0001 17 (11) <0.0001

Renal failure

19 (24) 93 (19) 0.39 37 (6) <0.0001 17 (11) 0.008

Malignancy

13 (17) 97 (20) 0.47 48 (8) 0.02 30 (20) 0.58
Health care–associated risk factors, past 12 mo

Hospitalization

58 (74) 296 (62) 0.03 148 (26) <0.0001 58 (38) <0.0001

Use of invasive device

35 (45) 168 (35) 0.09 66 (12) <0.0001 35 (23) 0006

Surgery

35 (45) 179 (37) 0.19 79 (14) <0.0001 33 (22) 0.0002

History of MRSA infection

26 (33) 77 (16) 0.0003 82 (14) <0.0001 29 (19) 0.015

Stay in long-term care facility

22 (28) 155 (32) 0.47 34 (6) <0.0001 14 (9) 0.0002

Hemodialysis

15 (19) 47 (10) 0.068 18 (3) <0.0001 10(7) 0.015

Other

10 (13) 29 (6) 0.03 40 (7) 0.06 7 (5) 0.02
Invasive devices <7 d before infection

Central venous catheter

25 (32) 156 (32) 0.94 61 (11) <0.0001 32 (21) 0.06

Foley catheter

17 (22) 99 (21) 0.8 55 (10) 0.001 17 (11) 0.03

Hemodialysis

13 (17) 49 (10) 0.02 19 (3) <0.0001 8 (5) 0.008

Mechanical ventilation

14 (18) 85 (18) 0.95 35 (6) 0.0002 11 (7) 0.012

Drainage tubes

8 (10) 50 (10) 0.97 10 (2) <0.0001 5 (3) 0.02

Total parenteral nutrition

8 (10) 22 (5) 0.04 4 (1) <0.0001 0 0.0001

Other

20 (26) 71 (15) 0.016 39 (7) <0.0001 15 (10) 0.0015
Classification of MRSA infection

Health care associated

32 (41) 197 (41) 0.97 63 (11) <0.0001 37 (24) 0.01

Health care associated community onset

42 (54) 214 (44) 0.12 113 (20) <0.0001 49 (32) 0.0012

Community associated

4 (5) 70 (15) 0.02 398 (69) <0.0001 67 (44) <0.0001
Outcome

Cure

23 (29) 149 (31) 0.81 94 (16) 0.005 38 (25) 0.49

Failure

3 (4) 7 (1.5) 0.14 12 (2) 0.33 5 (3) 0.81

Relapse

4 (5) 7 (1.5) 0.03 2 (1) 0.0001 1 (1) 0.022

Recurrent

11 (14) 45 (9) 0.2 36 (6) 0.012 3 (2) 0.0002

Indeterminate

20 (26) 192 (40) 0.015 408 (71) 0.001 97 (63) 0.0001

Death

17 (22) 81 (17) 0.29 22 (4) 0.001 9 (6) 0.0003
No. patients admitted 74 429 0.005 310 0.0003 111 0.003

Admitting service

Intensive care unit

14 (19) 58 (14) 0.2 29 (9) 0.019 9 (8) 0.047

Medicine service

31 (42) 238 (55) 0.03 203 (66) 0.0002 75 (68) 0.0007

Surgery service

20 (27) 117 (27) 0.95 59 (19) 0.12 20 (18) 0.126

Other specialty care unit†

9 (12) 16 (4) 0.002 19 (6) 0.073 7 (6) 0.16
Destination after discharge

Home

20 (27) 146 (34) 0.24 209 (67) <0.0001 60 (54) 0.0003

Another facility, long-term care center, or rehabilitation center

35 (47) 204 (48) 0.97 79 (24) <0.0001 40 (36) 0.12
Median duration of hospitalization,‡ d (range) 16 (1–143) 11 (0–136) 0.07 6 (0–169) <0.0001 9 (1–124) 0.01

*Values are no. (%) unless otherwise indicated. MRSA, methicillin-resistant Staphylococcus aureus; ST, sequence type; NA, not applicable. The p-values were generated to assess whether differences in demographic and risk factor history existed between ST239 and other strains (USA100, USA300, all other strains). χ2 tests were used for categorical variables and t-tests were used for continuous variables.
†Other specialty care unit admitting services included bone marrow, cardiology, hematology, surgical oncology, transplant, and obstetrics and gynecology.
‡Duration of hospitalization and days to MRSA culture–positive included only inpatients; outpatient visits such as clinic or emergency department visits were excluded from the analysis. Duration of hospitalization was calculated from the date of the current hospital admission to the date of discharge. Hospitalization days at another institution before transfer were not included.

Main Article

1Presented in part at the 48th Annual Meeting of the Infectious Diseases Society of America, Vancouver, British Columbia, Canada, October 21–24, 2010.

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