Association of bacterial genotypes and epidemiological features with treatment failure in hemodialysis patients with methicillin-resistant <i>Staphylococcus aureus</i> bacteremia

<div><p>Objectives</p><p>Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections in the hemodialysis (HD) population are epidemiologically classified as healthcare-associated infections. The data about the clinical impact and bacterial characteristics of hospital-onset (HO)- and community-onset (CO)-MRSA in HD patients are scarce. The current study analyzed the difference in the clinical and molecular characteristics of HO-MRSA and CO-MRSA.</p><p>Methods</p><p>We performed a retrospective review and molecular analysis of clinical isolates from 106 HD patients with MRSA bacteremia from 2009 to 2014. CA genotypes were defined as isolates carrying the SCC<i>mec</i> type IV or V, and HA genotypes were defined as isolates harboring SCC<i>mec</i> type I, II, or III.</p><p>Results</p><p>CO-MRSA infections occurred in 76 patients, and 30 patients had HO-MRSA infections. There was no significant difference in the treatment failure rates between patients with CO-MRSA infections and those with HO-MRSA infections. CA genotypes were associated with less treatment failure (odds ratio [OR]: 0.18; 95% confidence interval [95% CI], 0.07–0.49; <i>p</i> = 0.001). For isolates with a vancomycin minimum inhibitory concentration (MIC) < 1.5 mg/L, the multivariate analysis revealed that HA genotypes and cuffed tunneled catheter use were associated with treatment failure. For isolates with a vancomycin MIC ≥1.5 mg/L, the only risk factor for treatment failure was a higher Pitt score (OR: 1.76; 95% CI, 1.02–3.05; <i>p</i> = 0.043).</p><p>Conclusion</p><p>CA genotypes, but not the epidemiological classification of CO-MRSA, impacted the clinical outcome of MRSA bacteremia in the HD population.</p></div

Demographic data, clinical features, molecular characteristics and therapeutic characteristics between healthcare-associated community onset (CO)- and healthcare-associated hospital onset (HO)- methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections in hemodialysis patients.

<p>Demographic data, clinical features, molecular characteristics and therapeutic characteristics between healthcare-associated community onset (CO)- and healthcare-associated hospital onset (HO)- methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections in hemodialysis patients.</p

Multivariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.

<p>Multivariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.</p

Univariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.

<p>Univariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.</p

Appendix E. Classifications of 78 bird species surveyed by Baker et al. (2002) in woodland and heath plots in southeastern Australia.

Classifications of 78 bird species surveyed by Baker et al. (2002) in woodland and heath plots in southeastern Australia

Appendix B. Tree species ≥ 10 cm DBH and their abundance in old-growth and second-growth study areas described in Appendix A.

Tree species ≥ 10 cm DBH and their abundance in old-growth and second-growth study areas described in Appendix A

Appendix A. Description of vegetation inventory data sets used in this study.

Description of vegetation inventory data sets used in this study

Appendix D. Testing for specialization under the multinomial model, using a super-majority threshold.

Testing for specialization under the multinomial model, using a super-majority threshold

Appendix C. The effect of undetected species on estimated species frequencies.

The effect of undetected species on estimated species frequencies