Methicillin-Resistant Staphylococcus aureus SCCmec Type and Its Association with Clinical Presentation, Severity, and Length of Stay among Patients with Complicated Skin and Skin Structure Infections

Eric Gomez, Tom Chiang, Patricia A. Hogan, Daniela E. Myers, David B. Huang

Appalachian Regional Healthcare, Beckley, USA.
Pfizer Inc., Collegeville, USA.
Rutgers Medical School, Newark, USA.
Veterans Affairs New Jersey Healthcare System (VA NJHCS), East Orange, USA.

DOI: 10.4236/aid.2014.42017                

Abstract

Data from a prospective, randomized, open-label, active-controlled, multicenter, Phase 4 study comparing oral or intravenous linezolid with intravenous vancomycin for treatment of complicated skin and soft-tissue infections caused by methicillin resistant Staphylococcus aureus was used to determine the association between staphylococcal cassette chromosome mec (SCCmec) type and patient’s clinical presentation, infection severity, intravenous therapy duration and length of stay (LOS). Compared to SCCmec types I, II, and III, SCCmec type IV, PVL+ was associated with more frequent presentation of abscesses, lower severity scores, and shorter intravenous therapy duration and LOS in both treatment groups.

Keywords

MRSA, SCCmec Type, Infection Severity, Length of Stay

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Itani, K.M., Dryden, M.S., Bhattacharyya, H., Kunkel, M.J., Baruch, A.M. and Weigelt, J.A. (2010) Efficacy and Safety of Linezolid versus Vancomycin for the Treatment of Complicated Skin and Soft-Tissue Infections Proven to Be Caused by Methicillin-Resistant Staphylococcus aureus. American Journal of Surgery, 199, 804-816. http://dx.doi.org/10.1016/j.amjsurg.2009.08.045
[2]	Mendes, R.E., Sader, H.S., Deshpande, L.M., Diep, B.A., Chambers, H.F. and Jones, R.N. (2010) Characterization of Baseline Methicillin-Resistant Staphylococcus aureus Isolates Recovered from Phase IV Clinical Trial for Linezolid. Journal of Clinical Microbiology, 48, 568-574. http://dx.doi.org/10.1128/JCM.01384-09
[3]	DeLeo, F.R., Otto, M., Kreiswirth, B.N. and Chambers, H.F. (2010) Community-Associated Meticillin-Resistant Staphylococcus aureus. Lancet, 375, 1557-1568. http://dx.doi.org/10.1016/S0140-6736(09)61999-1
[4]	Wilson, S.E., Solomkin, J.S., Le, V., Cammarata, S.K. and Bruss, J.B. (2003) A Severity Score for Complicated Skin and Soft Tissue Infections Derived from Phase III Studies of Linezolid. American Journal of Surgery, 185, 369-375. http://dx.doi.org/10.1016/S0002-9610(02)01411-3
[5]	Ganga, R., Riederer, K., Sharma, M., Fakih, M.G., Johnson, L.B., Shemes, S. and Khatib, R. (2009) Role of SCCmec Type in Outcome of Staphylococcus aureus Bacteremia in a Single Medical Center. Journal of Clinical Microbiology, 47, 590-595. http://dx.doi.org/10.1128/JCM.00397-08
[6]	Huang, D.B., Reisman, A. and Hogan, P. (2010) Clinical Outcomes by Methicillin-Resistant Staphylococcus aureus Staphylococcal Cassette Chromosome mec Type: Isolates Recovered from a Phase IV Clinical Trial of Linezolid and Vancomycin for Complicated Skin and Skin Structure Infections. Antimicrobial Agents and Chemotherapy, 54, 4036-4037. http://dx.doi.org/10.1128/AAC.00044-10
[7]	Wang, J.L., Wang, J.T., Chen, S.Y., Chen, Y.C. and Chang, S.C. (2010) Distribution of Staphylococcal Cassette Chromosome mec Types and Correlation with Comorbidity and Infection Type in Patients with MRSA Bacteremia. PloS One, 5, e9489. http://dx.doi.org/10.1371/journal.pone.0009489
[8]	Davis, S.L., Rybak, M.J., Amjad, M., Kaatz, G.W. and McKinnon, P.S. (2006) Characteristics of Patients with Health-care-Associated Infection Due to SCCmec Type IV Methicillin-Resistant Staphylococcus aureus. Infection Control and Hospital Epidemiology, 27, 1025-1031. http://dx.doi.org/10.1086/507918
[9]	Diep, B.A., Sensabaugh, G.F., Somboonna, N., Carleton, H.A. and Perdreau-Remington, F. (2004) Widespread Skin and Soft-Tissue Infections Due to Two Methicillin-Resistant Staphylococcus aureus Strains Harboring the Genes for Panton-Valentine Leucocidin. Journal of Clinical Microbiology, 42, 2080-2084. http://dx.doi.org/10.1128/JCM.42.5.2080-2084.2004
[10]	Bae, I.G., Tonthat, G.T., Stryjewski, M.E., Rude, T.H., Reilly, L.F., Barriere, S.L., Genter, F.C., Corey, G.R. and Fowler Jr., V.G. (2009) Presence of Genes Encoding the Panton-Valentine Leukocidin Exotoxin Is Not the Primary Determinant of Outcome in Patients with Complicated Skin and Skin Structure Infections Due to Methicillin-Resistant Staphylococcus aureus: Results of a Multinational Trial. Journal of Clinical Microbiology, 47, 3952-3957. http://dx.doi.org/10.1128/jcm.01643-09