Agr dysfunction affects Staphylococcal cassette chromosome mec type-dependent clinical outcomes in methicillin-resistant Staphylococcus aureus bacteremia

Chang Kyung Kang, Jeong Eun Cho, Yoon Jeong Choi, Younghee Jung, Nak Hyun Kim, Chung Jong Kim, Taek Soo Kim, Kyoung Ho Song, Pyoeng Gyun Choe, Wan Beom Park, Ji Hwan Bang, Eu Suk Kim, Kyoung Un Park, Sang Won Park, Nam Joong Kim, Myoung Don Oh, Hong Bin Kim

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Staphylococcal cassette chromosome mec element (SCCmec) type-dependent clinical outcomes may vary due to geographical variation in the presence of virulence determinants. We compared the microbiological factors and mortality attributed to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia between SCCmec types II/III and type IV. All episodes of MRSA bacteremia in a tertiary-care hospital (South Korea) over a 4.5-year period were reviewed. We studied the microbiological factors associated with all blood MRSA isolates, including spa type, agr type, agr dysfunction, and the genes for Panton-Valentine leukocidin (PVL) and phenol-soluble modulin (PSM)-mec, in addition to SCCmec type. Of 195 cases, 137 involved SCCmec types II/III, and 58 involved type IV. The mortality attributed to MRSA bacteremia was less frequent among the SCCmec type IV (5/58) than that among types II/III (39/137, P=0.002). This difference remained significant when adjusted for clinical factors (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.04 to 0.49; P=0.002). Of the microbiological factors tested, agr dysfunction was the only significant factor that showed different positivity between the SCCmec types, and it was independently associated with MRSA bacteremia-attributed mortality (aOR, 4.71; 95% CI, 1.72 to 12.92; P=0.003). SCCmec type IV is associated with lower MRSA bacteremia-attributed mortality than are types II/III, which might be explained by the high rate of agr dysfunction in SCCmec types II/III in South Korea.

Original languageEnglish
Pages (from-to)3125-3132
Number of pages8
JournalAntimicrobial Agents and Chemotherapy
Volume59
Issue number6
DOIs
StatePublished - 2015

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