Ann Lab Med 2019; 39(2): 158-166
Impact of Community-Onset Methicillin-Resistant Staphylococcus aureus on Staphylococcus aureus Bacteremia in a Central Korea Veterans Health Service Hospital
Eunsin Bae, M.D.1, Choon Kwan Kim, M.D.2, Jung-Hyun Jang, M.D.3, Heungsup Sung, M.D.3, YounMi Choi, M.D., Ph.D.1, and Mi-Na Kim, M.D., Ph.D.3
Departments of 1Laboratory Medicine and 2Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea; 3Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
Corresponding author: Mi-Na Kim, M.D.
Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-4511
Fax: +82-2-3010-4510
YounMi Choi, M.D.
Department of Laboratory Medicine, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61 gil, Gangdong-gu, Seoul 05368, Korea
Tel: +82-2-2225-1459
Fax: +82-2-2225-4103
Received: January 21, 2018; Revised: May 18, 2018; Accepted: October 4, 2018; Published online: March 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

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Background: No study has examined the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in Korean veterans’ hospitals. We investigated the microbiological and clinical epidemiology of S. aureus bacteremia at the central Veterans Health Services (VHS) hospital in Korea.
Methods: Patients with S. aureus bacteremia were consecutively enrolled from February to August 2015. Bacteremia was classified as hospital-acquired (HA), community-onset healthcare-associated (COHA), or community-acquired (CA). MRSA bacteremia risk factors were analyzed. Species identification, antimicrobial susceptibility, and presence of luk and tst were tested. Staphylococcal cassette chromosome mec (SCCmec) typing, spa sequence typing agr polymorphism typing, and multilocus sequence typing were performed. Biofilm production and δ-hemolysin activity were measured to determine agr function.
Results: In total, 60 patients were enrolled (30 HA, 23 COHA, and seven CA bacteremia); 44 (73.3%) had MRSA bacteremia (26 HA, 16 COHA, and two CA). MRSA bacteremia occurred more frequently in non-CA patients and those who had received antibiotic treatment within the past month (P<0.05). The major MRSA strains comprised 24 ST5-agr2-SCCmecII, 11 ST72-agr 1-SCCmecIV, and five ST8-agr1-SCCmecIV strains. Of 26 agr2-SCCmecII strains, including two MSSA strains, 25 were multidrug-resistant, 18 were tst-positive, and 13 were agr-defective, whereas only five of the 18 agr1-SCCmecIV strains were multidrug-resistant, and all were tst-negative and agr-intact. agr1-SCCmecIV and ST8-agr1-SCCmecIV strains were more likely than agr2-SCCmecII strains to be COHA.
Conclusions: MRSA was highly prevalent in both COHA and HA bacteremia. The introduction of virulent CA-MRSA strains may be an important cause of increased HA-MRSA bacteremia in VHS hospitals.
Keywords: Community onset, Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Bacteremia, Healthcare-associated, Veterans hospital, Korea

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