Community-acquired methicillin-resistant Staphylococcus aureus bacteremia in Taiwan: risk factors for acquisition, clinical features and outcome.

The prevalence of community-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in Taiwan has increased markedly in the past decade. This study investigated the risk factors for acquisition, the clinical features, and the outcome of community-acquired MRSA bacteremia. Data were collected from records of 86 patients with community-acquired S. aureus bacteremia admitted to a tertiary teaching hospital in Taipei from January 1994 to December 1999. MRSA accounted for 26% (22/86) of isolated pathogens. Over 90% of patients with S. aureus bacteremia had one or more underlying diseases. Significantly more patients with MRSA bacteremia [vs methicillin-susceptible S. aureus (MSSA) bacteremia] had congenital and valvular heart diseases (18% vs 0%, p=0.004), an initial presentation of acute respiratory failure (32% vs 11%, p=0.022), an implant as a portal of entry (9% vs 0%, p=0.014), and mortality (41% vs 20%, p=0.05). Acute Physiology and Chronic Health Evaluation (APACHE) III score was significantly higher in patients who died than in patients who survived in both the MRSA and MSSA bacteremia groups. Inappropriate treatment was more frequent in patients with MRSA bacteremia than in MSSA bacteremia. When a Gram-positive coccemia is initially noted in a patient with high APACHE III score and/or acute respiratory failure, early and aggressive treatment including glycopeptide should be considered.