Toxic shock syndrome toxin 1-producing methicillin-resistant staphylococcus aureus of clonal complex 5, the New York/ Japan Epidemic Clone, causing a high early-mortality rate in patients with bloodstream infections

Dokyun Kim, Jun Sung Hong, Eun Jeong Yoon, Hyukmin Lee, Young Ah Kim, Kyeong Seob Shin, Jeong Hwan Shin, Young Uh, Jong Hee Shin, Yoon Soo Park, Seok Hoon Jeong

Research output: Contribution to journalArticle

Abstract

This study was performed to evaluate the clinical impacts of putative risk factors in patients with Staphylococcus aureus bloodstream infections (BSIs) through a prospective, multicenter, observational study. All 567 patients with S. aureus BSIs that occurred during a 1-year period in six general hospitals were included in this study. Host- and pathogen-related variables were investigated to determine risk factors for the early mortality of patients with S. aureus BSIs. The all-cause mortality rate was 15.0% (85/567) during the 4-week follow-up period from the initial blood culture, and 76.5% (65/85) of the mortality cases occurred within the first 2 weeks. One-quarter (26.8%, 152/567) of the S. aureus blood isolates carried the tst-1 gene, and most (86.2%, 131/152) of them were identified to be clonal complex 5 agr type 2 methicillin-resistant S. aureus (MRSA) strains harboring staphylococcal cassette chromosome mec type II, belonging to the New York/Japan epidemic clone. A multivariable logistic regression showed that the tst-1 positivity of the causative S. aureus isolates was associated with an increased 2-week mortality rate both in patients with S. aureus BSIs (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 0.90 to 2.88) and in patients with MRSA BSIs (aOR, 2.61; 95% CI, 1.19 to 6.03). Two host-related factors, an increased Pitt bacteremia score and advanced age, as well as a pathogen-related factor, carriage of tst-1 by causative MRSA isolates, were risk factors for 2-week mortality in patients with BSIs. Careful management of patients with BSIs caused by the New York/Japan epidemic clone is needed to improve clinical outcomes.

Original languageEnglish
Article numbere0136219
JournalAntimicrobial agents and chemotherapy
Volume63
Issue number11
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Methicillin-Resistant Staphylococcus aureus
Japan
Clone Cells
Staphylococcus aureus
Mortality
Infection
Odds Ratio
Confidence Intervals
Bacteremia
Staphylococcal enterotoxin F
General Hospitals
Multicenter Studies
Observational Studies
Chromosomes
Logistic Models
Genes

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Kim, Dokyun ; Hong, Jun Sung ; Yoon, Eun Jeong ; Lee, Hyukmin ; Kim, Young Ah ; Shin, Kyeong Seob ; Shin, Jeong Hwan ; Uh, Young ; Shin, Jong Hee ; Park, Yoon Soo ; Jeong, Seok Hoon. / Toxic shock syndrome toxin 1-producing methicillin-resistant staphylococcus aureus of clonal complex 5, the New York/ Japan Epidemic Clone, causing a high early-mortality rate in patients with bloodstream infections. In: Antimicrobial agents and chemotherapy. 2019 ; Vol. 63, No. 11.
@article{2229ccb23a8741a6b6fb558676c5c55a,
title = "Toxic shock syndrome toxin 1-producing methicillin-resistant staphylococcus aureus of clonal complex 5, the New York/ Japan Epidemic Clone, causing a high early-mortality rate in patients with bloodstream infections",
abstract = "This study was performed to evaluate the clinical impacts of putative risk factors in patients with Staphylococcus aureus bloodstream infections (BSIs) through a prospective, multicenter, observational study. All 567 patients with S. aureus BSIs that occurred during a 1-year period in six general hospitals were included in this study. Host- and pathogen-related variables were investigated to determine risk factors for the early mortality of patients with S. aureus BSIs. The all-cause mortality rate was 15.0{\%} (85/567) during the 4-week follow-up period from the initial blood culture, and 76.5{\%} (65/85) of the mortality cases occurred within the first 2 weeks. One-quarter (26.8{\%}, 152/567) of the S. aureus blood isolates carried the tst-1 gene, and most (86.2{\%}, 131/152) of them were identified to be clonal complex 5 agr type 2 methicillin-resistant S. aureus (MRSA) strains harboring staphylococcal cassette chromosome mec type II, belonging to the New York/Japan epidemic clone. A multivariable logistic regression showed that the tst-1 positivity of the causative S. aureus isolates was associated with an increased 2-week mortality rate both in patients with S. aureus BSIs (adjusted odds ratio [aOR], 1.62; 95{\%} confidence interval [CI], 0.90 to 2.88) and in patients with MRSA BSIs (aOR, 2.61; 95{\%} CI, 1.19 to 6.03). Two host-related factors, an increased Pitt bacteremia score and advanced age, as well as a pathogen-related factor, carriage of tst-1 by causative MRSA isolates, were risk factors for 2-week mortality in patients with BSIs. Careful management of patients with BSIs caused by the New York/Japan epidemic clone is needed to improve clinical outcomes.",
author = "Dokyun Kim and Hong, {Jun Sung} and Yoon, {Eun Jeong} and Hyukmin Lee and Kim, {Young Ah} and Shin, {Kyeong Seob} and Shin, {Jeong Hwan} and Young Uh and Shin, {Jong Hee} and Park, {Yoon Soo} and Jeong, {Seok Hoon}",
year = "2019",
month = "1",
day = "1",
doi = "10.1128/AAC.01362-19",
language = "English",
volume = "63",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
number = "11",

}

Toxic shock syndrome toxin 1-producing methicillin-resistant staphylococcus aureus of clonal complex 5, the New York/ Japan Epidemic Clone, causing a high early-mortality rate in patients with bloodstream infections. / Kim, Dokyun; Hong, Jun Sung; Yoon, Eun Jeong; Lee, Hyukmin; Kim, Young Ah; Shin, Kyeong Seob; Shin, Jeong Hwan; Uh, Young; Shin, Jong Hee; Park, Yoon Soo; Jeong, Seok Hoon.

In: Antimicrobial agents and chemotherapy, Vol. 63, No. 11, e0136219, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Toxic shock syndrome toxin 1-producing methicillin-resistant staphylococcus aureus of clonal complex 5, the New York/ Japan Epidemic Clone, causing a high early-mortality rate in patients with bloodstream infections

AU - Kim, Dokyun

AU - Hong, Jun Sung

AU - Yoon, Eun Jeong

AU - Lee, Hyukmin

AU - Kim, Young Ah

AU - Shin, Kyeong Seob

AU - Shin, Jeong Hwan

AU - Uh, Young

AU - Shin, Jong Hee

AU - Park, Yoon Soo

AU - Jeong, Seok Hoon

PY - 2019/1/1

Y1 - 2019/1/1

N2 - This study was performed to evaluate the clinical impacts of putative risk factors in patients with Staphylococcus aureus bloodstream infections (BSIs) through a prospective, multicenter, observational study. All 567 patients with S. aureus BSIs that occurred during a 1-year period in six general hospitals were included in this study. Host- and pathogen-related variables were investigated to determine risk factors for the early mortality of patients with S. aureus BSIs. The all-cause mortality rate was 15.0% (85/567) during the 4-week follow-up period from the initial blood culture, and 76.5% (65/85) of the mortality cases occurred within the first 2 weeks. One-quarter (26.8%, 152/567) of the S. aureus blood isolates carried the tst-1 gene, and most (86.2%, 131/152) of them were identified to be clonal complex 5 agr type 2 methicillin-resistant S. aureus (MRSA) strains harboring staphylococcal cassette chromosome mec type II, belonging to the New York/Japan epidemic clone. A multivariable logistic regression showed that the tst-1 positivity of the causative S. aureus isolates was associated with an increased 2-week mortality rate both in patients with S. aureus BSIs (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 0.90 to 2.88) and in patients with MRSA BSIs (aOR, 2.61; 95% CI, 1.19 to 6.03). Two host-related factors, an increased Pitt bacteremia score and advanced age, as well as a pathogen-related factor, carriage of tst-1 by causative MRSA isolates, were risk factors for 2-week mortality in patients with BSIs. Careful management of patients with BSIs caused by the New York/Japan epidemic clone is needed to improve clinical outcomes.

AB - This study was performed to evaluate the clinical impacts of putative risk factors in patients with Staphylococcus aureus bloodstream infections (BSIs) through a prospective, multicenter, observational study. All 567 patients with S. aureus BSIs that occurred during a 1-year period in six general hospitals were included in this study. Host- and pathogen-related variables were investigated to determine risk factors for the early mortality of patients with S. aureus BSIs. The all-cause mortality rate was 15.0% (85/567) during the 4-week follow-up period from the initial blood culture, and 76.5% (65/85) of the mortality cases occurred within the first 2 weeks. One-quarter (26.8%, 152/567) of the S. aureus blood isolates carried the tst-1 gene, and most (86.2%, 131/152) of them were identified to be clonal complex 5 agr type 2 methicillin-resistant S. aureus (MRSA) strains harboring staphylococcal cassette chromosome mec type II, belonging to the New York/Japan epidemic clone. A multivariable logistic regression showed that the tst-1 positivity of the causative S. aureus isolates was associated with an increased 2-week mortality rate both in patients with S. aureus BSIs (adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 0.90 to 2.88) and in patients with MRSA BSIs (aOR, 2.61; 95% CI, 1.19 to 6.03). Two host-related factors, an increased Pitt bacteremia score and advanced age, as well as a pathogen-related factor, carriage of tst-1 by causative MRSA isolates, were risk factors for 2-week mortality in patients with BSIs. Careful management of patients with BSIs caused by the New York/Japan epidemic clone is needed to improve clinical outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85073764791&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073764791&partnerID=8YFLogxK

U2 - 10.1128/AAC.01362-19

DO - 10.1128/AAC.01362-19

M3 - Article

C2 - 31501145

AN - SCOPUS:85073764791

VL - 63

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 11

M1 - e0136219

ER -