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J Infect Dis DOI:10.1093/infdis/jit501

Staphylococcal enterotoxin P predicts bacteremia in hospitalized patients colonized with methicillin-resistant Staphylococcus aureus.

Publication TypeJournal Article
Year of Publication2014
AuthorsCalderwood, MS, Desjardins, CA, Sakoulas, G, Nicol, R, Dubois, A, Delaney, ML, Kleinman, K, Cosimi, LA, Feldgarden, M, Onderdonk, AB, Birren, BW, Platt, R, Huang, SS
Corporate AuthorsCDC Prevention Epicenters Program
JournalJ Infect Dis
Date Published2014 Feb 15
KeywordsAged, Aged, 80 and over, Bacteremia, Bacterial Toxins, Case-Control Studies, Enterotoxins, Female, Hospitalization, Humans, Intensive Care Units, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Risk Factors, Staphylococcal Infections

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) colonization predicts later infection, with both host and pathogen determinants of invasive disease.

METHODS: This nested case-control study evaluates predictors of MRSA bacteremia in an 8-intensive care unit (ICU) prospective adult cohort from 1 September 2003 through 30 April 2005 with active MRSA surveillance and collection of ICU, post-ICU, and readmission MRSA isolates. We selected MRSA carriers who did (cases) and those who did not (controls) develop MRSA bacteremia. Generating assembled genome sequences, we evaluated 30 MRSA genes potentially associated with virulence and invasion. Using multivariable Cox proportional hazards regression, we assessed the association of these genes with MRSA bacteremia, controlling for host risk factors.

RESULTS: We collected 1578 MRSA isolates from 520 patients. We analyzed host and pathogen factors for 33 cases and 121 controls. Predictors of MRSA bacteremia included a diagnosis of cancer, presence of a central venous catheter, hyperglycemia (glucose level, >200 mg/dL), and infection with a MRSA strain carrying the gene for staphylococcal enterotoxin P (sep). Receipt of an anti-MRSA medication had a significant protective effect.

CONCLUSIONS: In an analysis controlling for host factors, colonization with MRSA carrying sep increased the risk of MRSA bacteremia. Identification of risk-adjusted genetic determinants of virulence may help to improve prediction of invasive disease and suggest new targets for therapeutic intervention.


Alternate JournalJ. Infect. Dis.
PubMed ID24041793
PubMed Central IDPMC3903375
Grant ListHHSN272200900018C / AI / NIAID NIH HHS / United States
U54 CK000172 / CK / NCEZID CDC HHS / United States
1U54CK000172 / CK / NCEZID CDC HHS / United States
HHSN272200900018C / / PHS HHS / United States