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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Epidemiology and risk factors of Staphylococcus aureus CC398 bone and joint infections
Kevin Bouiller1, Didier Hocquet2,3,4, Marlene Sauget2,3,4
1Maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire, 25030, Besancon, France. kbouiller@chu-besancon.fr.
Background:
A particular ability of the Staphylococcus aureus clonal complex 398 (CC398) to cause bone and joint infections (BJI) remains questionable, since some studies have described high prevalence of MSSA CC398 in prosthetic joint infection (PJI) and diabetic foot ostemolyelitis (DFO). Here, we described the long-term epidemiology of CC398 among S. aureus isolated from BJI and identified risk factors associated with CC398.
Methods:
We included all bone and joint samples with S. aureus-positive culture in our university hospital between January 2010 and December 2017. Logistic regression was used for univariate and multivariate analysis.
Results:
We identified 124 CC398 isolates among the 958 BJI-associated S. aureus. The proportion of CC398 among S. aureus increased steadily from 4% in 2010 to 26% in 2017. Only 4 isolates of CC398 were resistant to methicillin. The distribution of BJI types due to CC398 and non CC398 isolates was similar. In multivariate analysis, age (p = 0.034, OR = 3.9), McCabe score (p = 0.005, OR = 5) and inoculation mechanism (p = 0.020, OR = 3.7) were associated with PJI-related CC398. The year of infection (p < 0.001, OR = 1.6), Charlson's score (p = 0.001, OR = 1.5) and grade 4 (severe) of the International Working Group of the Diabetic Foot classification (p < 0.001, OR = 8.5) were associated with DFO-related CC398.
Conclusion:
We highlighted here the emergence and spread of CC398-MSSA in BJI. Patients with comorbidities are at high risk of CC398 MSSA PJI and DFO. The spread of CC398 in the community and hospital settings remains unclear and further epidemiological studies are needed to identify the determinants of its success.
Insights
Staphylococcus aureus CC398, particularly methicillin-susceptible strains (MSSA), is increasingly causing bone and joint infections (BJI). Patients with comorbidities face higher risks for CC398-associated prosthetic joint infections and diabetic foot osteomyelitis.
Area of Science:
- Microbiology
- Epidemiology
- Infectious Diseases
Background:
- The role of Staphylococcus aureus clonal complex 398 (CC398) in bone and joint infections (BJI) is debated.
- Previous studies suggest a high prevalence of methicillin-susceptible S. aureus CC398 (MSSA CC398) in prosthetic joint infections (PJI) and diabetic foot osteomyelitis (DFO).
- This study investigates the long-term epidemiology of CC398 in BJI cases.
Purpose of the Study:
- To describe the long-term epidemiology of Staphylococcus aureus CC398 in bone and joint infections.
- To identify risk factors associated with CC398 in bone and joint infections, specifically PJI and DFO.
Main Methods:
- Retrospective analysis of S. aureus-positive bone and joint samples cultured between January 2010 and December 2017.
- Inclusion of all BJI cases with S. aureus-positive cultures.
- Logistic regression analysis (univariate and multivariate) to identify associated risk factors.
Main Results:
- CC398 accounted for 124 of 958 (13%) BJI-associated S. aureus isolates.
- The proportion of CC398 increased significantly from 4% in 2010 to 26% in 2017.
- Multivariate analysis identified age, McCabe score, and inoculation mechanism as risk factors for PJI-related CC398, while year of infection, Charlson's score, and severe diabetic foot classification were associated with DFO-related CC398.
Conclusions:
- There is a clear emergence and spread of methicillin-susceptible CC398 (MSSA CC398) in bone and joint infections.
- Patients with comorbidities are at increased risk for CC398-associated PJI and DFO.
- Further epidemiological studies are required to understand the spread of CC398 in community and hospital settings.
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