Analysis of Staphylococcal Toxins and Clinical Outcomes of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia

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  • Maeda Masayuki
    Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University
  • Shoji Hisashi
    Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University
  • Shirakura Tetsuro
    Department of Microbiology, School of Medicine, Showa University
  • Takuma Takahiro
    Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University
  • Ugajin Kazuhisa
    Department of Clinical Laboratory, Showa University Hospital
  • Fukuchi Kunihiko
    Department of Pathology, Showa University Hospital
  • Niki Yoshihito
    Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University
  • Ishino Keiko
    Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University

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  • Analysis of Staphylococcal Toxins and Clinical Outcomes of Methicillin-Resistant Staphylococcus aureus Bacteremia

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Abstract

It is well known that methicillin-resistant Staphylococcus aureus (MRSA) produces many virulence factors, such as hemolysins, leukocidins, proteases, enterotoxins, exfoliative toxins, and immune-modulatory factors. The aim of study was to identify staphylococcal pathogenicity that may affect the prognosis of patients with MRSA bacteremia. We obtained 149 MRSA strains from blood cultures between January 2009 and December 2014 in our institution. We collected information on patient characteristics, laboratory data, staphylococcal toxin genes, and susceptibility of the strain toward anti-MRSA agent and analyzed them as factors contributing to 30-d mortality. The “survival” and “dead” groups consisted of 103 and 46 patients, respectively. Multiple logistic regression analysis showed a four-fold increase in the risk of mortality in patients exhibiting isolated MRSA with staphylococcal enterotoxins (SEs) genes as well as toxic shock syndrome toxin-1 (TSST-1) genes [odds ratio: 3.89; 95% confidence interval: 1.20–12.60; p=0.024]. Kaplan–Meier analysis also showed significantly higher mortality in patient with isolated MRSA with SEs and TSST-1 genes. After adjusting for confounders, the coexistence of SEs and TSST-1 were independently associated with the 30-d mortality compared with treatment and susceptibility. The coexistence of superantigenic toxin genes greatly affects the clinical course and prognosis of patients with MRSA bacteremia.

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