Ann Lab Med.  2019 Mar;39(2):158-166. 10.3343/alm.2019.39.2.158.

Impact of Community-Onset Methicillin-Resistant Staphylococcus aureus on Staphylococcus aureus Bacteremia in a Central Korea Veterans Health Service Hospital

  • 1Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea.
  • 2Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.
  • 3Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.


No study has examined the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in Korean veterans' hospitals. We investigated the microbiological and clinical epidemiology of S. aureus bacteremia at the central Veterans Health Services (VHS) hospital in Korea.
Patients with S. aureus bacteremia were consecutively enrolled from February to August 2015. Bacteremia was classified as hospital-acquired (HA), community-onset healthcare-associated (COHA), or community-acquired (CA). MRSA bacteremia risk factors were analyzed. Species identification, antimicrobial susceptibility, and presence of luk and tst were tested. Staphylococcal cassette chromosome mec (SCCmec) typing, spa sequence typing agr polymorphism typing, and multilocus sequence typing were performed. Biofilm production and δ-hemolysin activity were measured to determine agr function.
In total, 60 patients were enrolled (30 HA, 23 COHA, and seven CA bacteremia); 44 (73.3%) had MRSA bacteremia (26 HA, 16 COHA, and two CA). MRSA bacteremia occurred more frequently in non-CA patients and those who had received antibiotic treatment within the past month (P < 0.05). The major MRSA strains comprised 24 ST5-agr2-SCCmecII, 11 ST72-agr 1-SCCmecIV, and five ST8-agr1-SCCmecIV strains. Of 26 agr2-SCCmecII strains, including two MSSA strains, 25 were multidrug-resistant, 18 were tst-positive, and 13 were agr-defective, whereas only five of the 18 agr1-SCCmecIV strains were multidrug-resistant, and all were tst-negative and agr-intact. agr1-SCCmecIV and ST8-agr1-SCCmecIV strains were more likely than agr2-SCCmecII strains to be COHA.
MRSA was highly prevalent in both COHA and HA bacteremia. The introduction of virulent CA-MRSA strains may be an important cause of increased HA-MRSA bacteremia in VHS hospitals.


Community onset; Staphylococcus aureus; Methicillin-resistant Staphylococcus aureus; Bacteremia; Healthcare-associated; Veterans hospital; Korea

MeSH Terms

Hospitals, Veterans
Methicillin Resistance*
Methicillin-Resistant Staphylococcus aureus*
Multilocus Sequence Typing
Risk Factors
Staphylococcus aureus*
Veterans Health*


  • Fig. 1 Cluster analysis based on spa typing of 60 Staphylococcus aureus strains isolated from blood cultures. The minimum spanning tree was constructed using Bionumerics software (Applied Maths, Sint-Martens-Latem, Belgium). Genotypes determined by using accessory gene regulator (agr) polymorphism and sequence type (ST) correlated well with spa typing clustering. Methicillin susceptibility, δ-hemolysin production, toxic shock syndrome toxin (TSST), and Panton–Valentine leukocidin (PVL) toxin were denoted.

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