Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain.
Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain.
Eur J Clin Microbiol Infect Dis. 2017 Oct;36(10):1757-1765. doi: 10.1007/s10096-017-2989-5. Epub 2017 May 5.
Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14-7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.
即使采用了适当的临床管理，复杂的耐甲氧西林金黄色葡萄球菌（MSSA）导管相关菌血症（CRB）也很常见。我们研究了 MSSA 菌株的分子特征对 MSSA-CRB 中复杂菌血症（CB）风险的影响。2011 年至 2014 年，在西班牙进行了一项多中心前瞻性研究，研究了 MSSA-CRB。需要优化方案指导的临床管理。CB 包括心内膜炎、感染性血栓性静脉炎、持续性菌血症和/或终末器官血源性播散。对所有 MSSA 分离株进行了分子分型、agr 功能和毒力因子 DNA 微阵列分析。在纳入的 83 例 MSSA-CRB 发作中，有 26 例（31.3%）发生 CB。MSSA 分离株属于 16 个克隆复合体（CCs），其中 CC30（32.5%）、CC5（15.7%）和 CC45（13.3%）最为常见。比较有无 CB 的 MSSA 分离株，agr 型和功能没有差异。然而，我们的结果表明，CC15 和 cna、chp 和 cap8 等基因的存在与 CB 的发生有关。多变量分析突出表明，cna 的存在（危险比 2.9；95%CI 1.14-7.6）与 CB 的发生相关。我们的结果表明，特定的 CC 和特定的基因可能影响 MSSA-CRB 的结局。
