358. Epidemiology of Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Co-infection among Patients with Candidemia in Atlanta, GA, 2008-2011
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • CaMRSA Coinfection IDWeek Poster_Submitted.pdf (784.6 kB)
  • Background: Patients with candidemia are often at risk for other invasive infections such as MRSA bloodstream infection (BSI). We sought to identify the risk factors for, and outcomes of, BSI with both Candida spp. and MRSA.

    Methods: The Georgia Emerging Infections Program conducts population-based surveillance for candidemia and invasive MRSA in Atlanta.  Charts of patients with incident candidemia from March 1, 2008 to November 30, 2011 were reviewed to identify those with co-infection, defined as incident MRSA BSI within 30 days of incident candidemia. Univariate analysis and multivariate logistic regression were performed for risk factors of co-infection including age, underlying conditions, previous healthcare events, antimicrobial treatment and species of Candida.

    Results: Of the 1,737 adult candidemia cases, the most common species were C. albicans (738; 42.5%), C. glabrata (493; 28.4%), C. parapsilosis (321; 18.5%), and C. tropicalis (157; 9.0%). There were 96 (5.5%) cases of co-infection; of those, MRSA BSI and candidemia onset occurred on the same day in 20 cases (20.8%) and occurred within 1 to 7 days for an additional 25 (26.0%). Co-infection was most frequent with C. tropicalis (13/157; 8.3%), C. glabrata (31/493; 6.3%), and C. albicans (42/738; 5.7%). Thirty day mortality was similar between co-infection cases and those with candidemia alone (43.8% vs. 35.4%, p=0.17).  Solid organ and other cancer, nursing home residence, prior hospital admission, hemodialysis, prior emergency surgery, hyperalimentation, and isolation of C. tropicalis were included in the initial model.  In the final model, only nursing home residence (OR=1.76, 95% CI [1.03,3.00]) and hemodialysis (OR=1.79, 95% CI [1.07,3.01]) predicted co-infection.

    Conclusion: A small but important proportion (5.5%) of patients with candidemia have MRSA co-infection, suggesting that heightened awareness is warranted after one major BSI pathogen is identified.  Mortality was similarly high comparing co-infection to candidemia alone.  C. tropicalis had the highest rate of co-infection though C. albicans was a more common cause of candidemia.  Hemodialysis patients and nursing home residents were at increased risk of co-infection and should be targeted in BSI prevention efforts.

    Jessica Reno, MPH1,2,3, Saumil S. Doshi, MD4, Janine Scott, MPH1,2,3, Betsy Stein, RN, BSN2,3,4, Monica M. Farley, MD2,3,4, Susan M. Ray, MD2,3,4 and Jesse T. Jacob, MD3,4, (1)Atlanta Research and Education Foundation, Decatur, GA, (2)Atlanta Veterans Affairs Medical Center, Decatur, GA, (3)Georgia Emerging Infections Program, Decatur, GA, (4)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA


    J. Reno, None

    S. S. Doshi, None

    J. Scott, None

    B. Stein, None

    M. M. Farley, None

    S. M. Ray, None

    J. T. Jacob, None

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