Methicillin-Resistant Staphylococcus aureau Infections
Top HIV Med. 2008 Dec-2009
Bartlett JG.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is epidemic in the community, differs from nosocomial MRSA in virulence, mechanisms, and antibiotic susceptibility, and exhibits diverse and often unique pathologic characteristics. The community-acquired MRSA USA 300 strains are transmitted largely by person-to-person contact and cause characteristic soft-tissue abscesses and, less commonly, other sometimes unusual and serious infections including a necrotizing pneumonia, and other necrotic infections such as necrotizing fasciitis, pelvic thrombophlebitis, and septic phlebitis. This MRSA 300 family remains susceptible to drugs active against nosocomial MRSA (ie, vancomycin, linezolid, daptomycin) and is often susceptible to trimethoprim-sulfamethoxazole, doxycycline, and clindamycin. Recent epidemiologic data indicate that nosocomial MRSA (eg, mainly USA 100) strains are also present in the community and that MRSA USA 300 strains are present in hospital settings, with both families found in intermediate frequency in health care-associated settings (eg, nursing homes, dialysis centers). More work is needed to identify effective barrier precautions to limit their spread. This article summarizes a presentation on MRSA made by John G. Bartlett, MD, at the 11th Annual Clinical Update for the Ryan White HIV/AIDS Program Clinicians held in August 2008 in Washington, DC. The original presentation is available as a Webcast at website.
Topics in HIV Medicine
Tuesday, December 30, 2008
Daptomycin for methicillin-resistant Staphylococcus aureus infections of the spine
Daptomycin for methicillin-resistant Staphylococcus aureus infections of the spine
Spine J. 2008 Dec 26
Spine J. 2008 Dec 26
Burdette SD.
Department of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA.
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is increasingly common. Treatment with vancomycin-based therapy is often unsuccessful. Daptomycin is a relatively new lipopeptide antibiotic with potent activity against MRSA.
PURPOSE: To describe the successful management of MRSA infection involving the spine.
STUDY DESIGN: Two case reports of MRSA infection, one involving epidural and lumbar subdural abscesses, the other with osteomyelitis and discitis.
METHODS: Two cases are described, one with lumbar epidural and subdural abscesses and the other with osteomyelitis and discitis of the spine. Switching from vancomycin to daptomycin plus rifampin-based therapy resulted in patient improvement that allowed discharge from the hospital.
RESULTS: Both patients recovered fully from their infection.
CONCLUSIONS: Daptomycin is a safe and effective option for the treatment of MRSA infection involving the spine.
PMID: 19112049 [PubMed - as supplied by publisher]
Monday, November 24, 2008
The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency dep
The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department.
N C Med J. 2008
Magilner D, Byerly MM, Cline DM.
Wake Forest University-School of Medicine, USA. dmagilne@wfubmc.edu
BACKGROUND: Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections have been increasing. The most common of these infections present as skin abscesses. The objectives of this study were to prospectively determine the prevalence of CA-MRSA in abscesses in the population of a pediatric emergency department, to determine antibiotic sensitivity patterns of the CA-MRSA isolates, and to describe the patient population that presented with skin abscesses.
METHODS: We conducted a prospective study of children under the age of 18 years who presented to our pediatric emergency department with a skin abscess that required incision and drainage. Pus from these abscesses was sent for culture to determine the causative agent, and antibiotic sensitivities were reported. Characteristics of the patient population that presented with these abscesses were examined.
RESULTS: Sixty-eight patients were enrolled over an 18-month period. Of these, 60 (88%) had cultures positive for Staphylococcus aureus (S. Aureus). Of these 60 patients, 51 (85%) were identified as CA-MRSA by their resistance patterns. All of the CA-MRSA isolates were sensitive to trimethoprim/sulfamethoxisole; 6 (10%) were either resistant or intermittently resistant to clindamycin.
LIMITATIONS: The study was conducted on a convenience sample of patients and enrolled a relatively small number of patients.
CONCLUSIONS: CA-MRSA is responsible for the vast majority of skin abscesses presenting to the pediatric emergency department. CA-MRSA isolates are likely to be sensitive to trimethoprim/sulfamethoxisole or clindamycin, although there is some resistance to clindamycin.
PubMed
N C Med J. 2008
Magilner D, Byerly MM, Cline DM.
Wake Forest University-School of Medicine, USA. dmagilne@wfubmc.edu
BACKGROUND: Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections have been increasing. The most common of these infections present as skin abscesses. The objectives of this study were to prospectively determine the prevalence of CA-MRSA in abscesses in the population of a pediatric emergency department, to determine antibiotic sensitivity patterns of the CA-MRSA isolates, and to describe the patient population that presented with skin abscesses.
METHODS: We conducted a prospective study of children under the age of 18 years who presented to our pediatric emergency department with a skin abscess that required incision and drainage. Pus from these abscesses was sent for culture to determine the causative agent, and antibiotic sensitivities were reported. Characteristics of the patient population that presented with these abscesses were examined.
RESULTS: Sixty-eight patients were enrolled over an 18-month period. Of these, 60 (88%) had cultures positive for Staphylococcus aureus (S. Aureus). Of these 60 patients, 51 (85%) were identified as CA-MRSA by their resistance patterns. All of the CA-MRSA isolates were sensitive to trimethoprim/sulfamethoxisole; 6 (10%) were either resistant or intermittently resistant to clindamycin.
LIMITATIONS: The study was conducted on a convenience sample of patients and enrolled a relatively small number of patients.
CONCLUSIONS: CA-MRSA is responsible for the vast majority of skin abscesses presenting to the pediatric emergency department. CA-MRSA isolates are likely to be sensitive to trimethoprim/sulfamethoxisole or clindamycin, although there is some resistance to clindamycin.
PubMed
Wednesday, November 12, 2008
First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture
First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome.
Diagn Microbiol Infect Dis. 2008 Nov 4
Woo PC, Lau SK, Yuen KY.
State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Department of Microbiology, The University of Hong Kong, Hong Kong.
We report the 1st case of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis after acupuncture, with articular cartilage destruction and chronic osteomyelitis. The patient responded to arthrotomy, synovectomy, and 6 months of antibiotics. The emergence of community-associated MRSA infections would further aggravate the problem. Strict adherence to proper infection control guidelines is mandatory.
Elsevier/ScienceDirect
Tuesday, November 4, 2008
Methicillin-resistant Staphylococcus aureus in orthopaedic surgery.
Methicillin-resistant Staphylococcus aureus in orthopaedic surgery.
J Bone Joint Surg Br. 2008 Nov
Patel A, Calfee RP, Plante M, Fischer SA, Arcand N, Born C.
Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island 02903, USA. patel_amar@msn.com
Methicillin-resistant Staphylococcus aureus (MRSA) has become a ubiquitous bacterium in both the hospital and community setting. There are two major subclassifications of MRSA, community-acquired and healthcare-acquired, each with differing pathogenicity and management. MRSA is increasingly responsible for infections in otherwise healthy, active adults. Local outbreaks affect both professional and amateur athletes and there is increasing public awareness of the issue. Health-acquired MRSA has major cost and outcome implications for patients and hospitals. The increasing prevalence and severity of MRSA means that the orthopaedic community should have a basic knowledge of the bacterium, its presentation and options for treatment. This paper examines the evolution of MRSA, analyses the spectrum of diseases produced by this bacterium and presents current prevention and treatment strategies for orthopaedic infections from MRSA.
PMID: 18978255 [PubMed - in process]
J Bone Joint Surg Br. 2008 Nov
Patel A, Calfee RP, Plante M, Fischer SA, Arcand N, Born C.
Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island 02903, USA. patel_amar@msn.com
Methicillin-resistant Staphylococcus aureus (MRSA) has become a ubiquitous bacterium in both the hospital and community setting. There are two major subclassifications of MRSA, community-acquired and healthcare-acquired, each with differing pathogenicity and management. MRSA is increasingly responsible for infections in otherwise healthy, active adults. Local outbreaks affect both professional and amateur athletes and there is increasing public awareness of the issue. Health-acquired MRSA has major cost and outcome implications for patients and hospitals. The increasing prevalence and severity of MRSA means that the orthopaedic community should have a basic knowledge of the bacterium, its presentation and options for treatment. This paper examines the evolution of MRSA, analyses the spectrum of diseases produced by this bacterium and presents current prevention and treatment strategies for orthopaedic infections from MRSA.
PMID: 18978255 [PubMed - in process]
Maternal-Infant Perinatal Transmission of Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus.
Maternal-Infant Perinatal Transmission of Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus.
Am J Perinatol. 2008 Oct 31
Pinter DM, Mandel J, Hulten KG, Minkoff H, Tosi MF.
Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York.
Because of the increasing importance of STAPHYLOCOCCUS AUREUS (SA), including methicillin-resistant SA (MRSA) in serious neonatal infections, we studied the contribution of perinatal maternal-infant transmission of SA to the colonization and infection of newborn infants. Cultures for SA, including MRSA, were obtained from nares and vagina of women in labor at term. Each mother's infant, if delivered vaginally, was cultured from nares and skin at delivery and again after 48 hours (at discharge). All MRSA and selected SA isolates were studied by pulsed field gel electrophoresis (PFGE). Infants were monitored after discharge for staphylococcal infection for 4 weeks. Of 304 women completing the study, 43 were colonized with SA, and 9/43 had MRSA. Of 252 evaluable infants, 25 were colonized with SA, and 9/25 had MRSA. Six of 252 mother-infant pairs were concordant for SA colonization, and one of these for MRSA. Isolates from five of these six infants were indistinguishable from their mother's isolates by PFGE, including the pair with MRSA. One SA-colonized infant and four noncolonized infants subsequently developed staphylococcal infections during the monitoring period. About 20% of SA isolates in this maternal population were MRSA. Perinatal maternal-infant transmission accounted for 20% of instances of perinatal colonization of infants with SA. Molecular confirmation of perinatal maternal-infant transmission of MRSA was first documented. In this population of term infants, most SA infections in the first 4 weeks of life appeared to result from colonization that occurred after discharge from the nursery.
[PubMed - as supplied by publisher]
Am J Perinatol. 2008 Oct 31
Pinter DM, Mandel J, Hulten KG, Minkoff H, Tosi MF.
Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York.
Because of the increasing importance of STAPHYLOCOCCUS AUREUS (SA), including methicillin-resistant SA (MRSA) in serious neonatal infections, we studied the contribution of perinatal maternal-infant transmission of SA to the colonization and infection of newborn infants. Cultures for SA, including MRSA, were obtained from nares and vagina of women in labor at term. Each mother's infant, if delivered vaginally, was cultured from nares and skin at delivery and again after 48 hours (at discharge). All MRSA and selected SA isolates were studied by pulsed field gel electrophoresis (PFGE). Infants were monitored after discharge for staphylococcal infection for 4 weeks. Of 304 women completing the study, 43 were colonized with SA, and 9/43 had MRSA. Of 252 evaluable infants, 25 were colonized with SA, and 9/25 had MRSA. Six of 252 mother-infant pairs were concordant for SA colonization, and one of these for MRSA. Isolates from five of these six infants were indistinguishable from their mother's isolates by PFGE, including the pair with MRSA. One SA-colonized infant and four noncolonized infants subsequently developed staphylococcal infections during the monitoring period. About 20% of SA isolates in this maternal population were MRSA. Perinatal maternal-infant transmission accounted for 20% of instances of perinatal colonization of infants with SA. Molecular confirmation of perinatal maternal-infant transmission of MRSA was first documented. In this population of term infants, most SA infections in the first 4 weeks of life appeared to result from colonization that occurred after discharge from the nursery.
[PubMed - as supplied by publisher]
Sunday, October 26, 2008
Community acquired infections with methicillin resistant strains of Staphylococcus aureus: Report of five cases
Community acquired infections with methicillin resistant strains of Staphylococcus aureus: Report of five cases
Rev Med Chil. 2008 Jul
Luis Miguel Noriega1,3, Patricia González2,3, Juan Carlos Hormazábal4, Consuelo Pinto3a, Magdalena Canals3a, José Manuel Munita1,3,5, Luis Thompson1,3, Alejandra Marcotti1,3, Jorge Pérez1,3,5, Daniel Ibáñez4, Pamela Araya4, Claudio Canals1,3, Pablo Vial1,2,3.
1Unidad de Infectología y Departamento de Medicina, Clínica Alemana, Santiago de Chile; 2Laboratorio Clínico, Clínica Alemana; 3Facultad de Medicina Clínica Alemana, Universidad del Desarrollo; 4Subdepartamento de Microbiología Clínica, Instituto de Salud Pública, Chile; 5Servicio Medicina, Hospital Padre Hurtado. Santiago de Chile. aEstudiantes de Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo
Rev Med Chil. 2008 Jul
Luis Miguel Noriega1,3, Patricia González2,3, Juan Carlos Hormazábal4, Consuelo Pinto3a, Magdalena Canals3a, José Manuel Munita1,3,5, Luis Thompson1,3, Alejandra Marcotti1,3, Jorge Pérez1,3,5, Daniel Ibáñez4, Pamela Araya4, Claudio Canals1,3, Pablo Vial1,2,3.
1Unidad de Infectología y Departamento de Medicina, Clínica Alemana, Santiago de Chile; 2Laboratorio Clínico, Clínica Alemana; 3Facultad de Medicina Clínica Alemana, Universidad del Desarrollo; 4Subdepartamento de Microbiología Clínica, Instituto de Salud Pública, Chile; 5Servicio Medicina, Hospital Padre Hurtado. Santiago de Chile. aEstudiantes de Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo
Community acquired infections with methicillin resistant strains of Staphylococcus aureus (MRSA) infections have a more aggresive clinical course and involve mostly skin and lungs. These infections appear as outbreaks among prisoners, spoñsmen, men having sex with men and military personnel. The higher aggressiveness of these strains is due to the production of several toxins, mainly Panton- Valentine leukocidine. The detection of the gene that codes for this toxin is a distinctive feature ofthese strains. We report five patients with community acquired MRSA infections. The clinicalpresentation was a skin infection in all. One patient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials, the strains were resistant to erythromycin and ciprofloxacin. Patients were treated with vancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. An epidemiológical surveillance for community acquired MRSA strain infections should be started and measures to adequately treat infected patients and avoid dissemination should be implemented.
Complete Text in Spanish
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