Hyeon Jeong Suh1, Wan Beom Park2, Sook-In Jung3, Kyoung-Ho Song1, Yee Gyung Kwak4, Kye-Hyung Kim5, Jeong-Hwan Hwang6, Na Ra Yun7, Hee-Chang Jang8, Young Keun Kim9, Nak-Hyun Kim1, Kyung-Hwa Park3, Seung Ji Kang8, Shinwon Lee5, Eu Suk Kim1, Hong Bin Kim1. 1. 1 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea. 2. 2 Department of Internal Medicine, Seoul National University Hospital , Seoul, Republic of Korea. 3. 3 Department of Internal Medicine, Chonnam National University Hospital , Gwangju, Republic of Korea. 4. 4 Department of Internal Medicine, Inje University Ilsan Paik Hospital , Goyang, Republic of Korea. 5. 5 Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital , Busan, Korea. 6. 6 Department of Internal Medicine, Chonbuk National University Hospital , Jeonju, Republic of Korea. 7. 7 Department of Internal Medicine, Chosun University Hospital , Gwangju, Republic of Korea. 8. 8 Department of Internal Medicine, Chonnam National University Hwasun Hospital , Hwasun, Republic of Korea. 9. 9 Department of Internal Medicine, Yonsei University Wonju College of Medicine Wonju Severance Christian Hospital , Wonju, Korea.
Abstract
AIMS: We aimed to develop a simple scoring system to predict risk for methicillin resistance in community-onset Staphylococcus aureus bacteremia (CO-SAB) by identifying the clinical and epidemiological risk factors for community-onset methicillin-resistant S. aureus (MRSA). METHODS: We retrospectively analyzed data from three multicenter cohort studies in Korea in which patient information was prospectively collected and risk factors for methicillin resistance in CO-SAB were identified. We then developed and validated a risk-scoring system. RESULTS: To analyze the 1,802 cases of CO-SAB, we included the four most powerful predictors of methicillin resistance that we identified in the scoring system: underlying hematologic disease (-1 point), endovascular infection as the primary site of infection (-1 point), history of hospitalization or surgery in ≤1 year (+0.5 points), and previous isolation of MRSA in ≤6 months (+1.5 points). With this scoring system, cases were classified into low (less than -0.5), intermediate (-0.5-1.5), and high (≥1.5) risk groups. The proportions of MRSA cases in each group were 24.7% (22/89), 39.0% (607/1,557), and 78.8% (123/156), respectively, and 16.7% (1/6), 33.8% (112/331), and 76.9% (10/13) in a validation set. CONCLUSIONS: This risk-scoring system for methicillin resistance in CO-SAB may help physicians select appropriate empirical antibiotics more quickly.
AIMS: We aimed to develop a simple scoring system to predict risk for methicillin resistance in community-onset Staphylococcus aureus bacteremia (CO-SAB) by identifying the clinical and epidemiological risk factors for community-onset methicillin-resistant S. aureus (MRSA). METHODS: We retrospectively analyzed data from three multicenter cohort studies in Korea in which patient information was prospectively collected and risk factors for methicillin resistance in CO-SAB were identified. We then developed and validated a risk-scoring system. RESULTS: To analyze the 1,802 cases of CO-SAB, we included the four most powerful predictors of methicillin resistance that we identified in the scoring system: underlying hematologic disease (-1 point), endovascular infection as the primary site of infection (-1 point), history of hospitalization or surgery in ≤1 year (+0.5 points), and previous isolation of MRSA in ≤6 months (+1.5 points). With this scoring system, cases were classified into low (less than -0.5), intermediate (-0.5-1.5), and high (≥1.5) risk groups. The proportions of MRSA cases in each group were 24.7% (22/89), 39.0% (607/1,557), and 78.8% (123/156), respectively, and 16.7% (1/6), 33.8% (112/331), and 76.9% (10/13) in a validation set. CONCLUSIONS: This risk-scoring system for methicillin resistance in CO-SAB may help physicians select appropriate empirical antibiotics more quickly.
Entities:
Keywords:
Staphylococcus aureus; bacteremia; community-onset; methicillin-resistant; risk-scoring system