Aims: We aimed to develop a simple scoring system to predict risk for methicillin resistance in community-onset Staphylococcus aureus bacteremia (CO-SAB) by identifying the clinical and epidemiological risk factors for community-onset methicillin-resistant S. aureus (MRSA). Methods: We retrospectively analyzed data from three multicenter cohort studies in Korea in which patient information was prospectively collected and risk factors for methicillin resistance in CO-SAB were identified. We then developed and validated a risk-scoring system. Results: To analyze the 1,802 cases of CO-SAB, we included the four most powerful predictors of methicillin resistance that we identified in the scoring system: underlying hematologic disease (-1 point), endovascular infection as the primary site of infection (-1 point), history of hospitalization or surgery in ≤1 year (+0.5 points), and previous isolation of MRSA in ≤6 months (+1.5 points). With this scoring system, cases were classified into low (less than-0.5), intermediate (-0.5-1.5), and high (≥1.5) risk groups. The proportions of MRSA cases in each group were 24.7% (22/89), 39.0% (607/1,557), and 78.8% (123/156), respectively, and 16.7% (1/6), 33.8% (112/331), and 76.9% (10/13) in a validation set. Conclusions: This risk-scoring system for methicillin resistance in CO-SAB may help physicians select appropriate empirical antibiotics more quickly.
Bibliographical noteFunding Information:
This study was performed using data from three multicenter cohorts. The first cohort from July 2009 to June 2011 was supported by grant No. 2009-E00609-00 from the Korea Centers for Disease Control and Prevention. The second cohort from May to December 2012 was supported by grant No. 2012-E44003-00 from the Korea Centers for Disease Control and Prevention. The last cohort from September 2013 to March 2015 was the prospective cohort study, ‘‘Korea INfectious Diseases Study Group/Staphylococcus aureus Bacteremia 2013 (KIND-SAB 2013) cohort’’ with project name, ‘‘Establishment of Network for Clinical Research of Staphylococcus aureus Infection’’. The KIND-SAB 2013 cohort was supported by Grant No. HI10C2020 from the National Strategic Coordinating Center for Clinical Research, which is run by the Ministry of Health and Welfare, Government of Korea. We have registered the protocol of the last KIND-SAB 2013 cohort study (KCT0001070) and the present comparative study (KCT0001088) with the Clinical Research Information Service of the Republic of Korea (http://cris.nih.go.kr) in cooperation with the WHO International Clinical Trials Registry Platform.
All Science Journal Classification (ASJC) codes
- Microbiology (medical)