Methicillin-Resistant Staphylococcus aureus Furunculitis in the Outpatient Burn Setting

Methicillin-Resistant Staphylococcus aureus Furunculitis in the Outpatient Burn Setting

J Burn Care Res. 2009 Jun

Warner P, Neely A, Bailey JK, Yakuboff KP, Kagan RJ.
From the *Shriners Hospitals for Children, Cincinnati, Ohio; and daggerUniversity of Cincinnati, Cincinnati, Ohio.

Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more predominant in the community. We have seen increasing cases of furunculitis in our outpatient burn clinic, which appear to develop weeks after the initial burn injury and in patients with limited inpatient stays. We performed a 3-year retrospective review of all outpatient burn patients who developed furunculitis. Data analyzed included length of hospital stay, type of injury sustained, culture and sensitivity results, and treatment provided. A total of 28 patients were identified with MRSA furunculitis, which presented as painful, hard, indurated boils with minimal purulent drainage. Adults had less extensive burn injuries (mean of 12% TBSA adults vs 20% TBSA children) with shorter hospital stays (mean 8 days adults vs 22 days children). Fifty-seven percent of the patients had multiple furuncules, involving both burned and nonburned areas. Patients with furunculitis had a less resistant MRSA strain than those without furunculitis. Of the 22 patients who received systemic antibiotic coverage, 14 (58%) were successfully treated with 1 antibiotic regimen, whereas 8 (33%) required multiple antibiotics. In this study, furunculitis in the outpatient setting was believed to be consistent with community-acquired MRSA. Incision and drainage was not sufficient in patients with multiple furuncles, and systemic antibiotics were administered. Through increased awareness of the prevalence of community-acquired MRSA in the community, appropriate antibiotic treatment can be initiated, and the discomfort and transmission risk associated with this disease can be minimized.

Lippincott, Williams & Wilkins

Topical Therapy for Methicillin-Resistant Staphylococcus aureus Colonization: Impact on Infection Risk.

Topical Therapy for Methicillin-Resistant Staphylococcus aureus Colonization: Impact on Infection Risk.

Infect Control Hosp Epidemiol. 2009 Jun

Robicsek A, Beaumont JL, Thomson Jr RB, Govindarajan G, Peterson LR.
From the Departments of Medicine (A.R.) and Pathology (R.B.T., L.R.P.), Feinberg School of Medicine, Northwestern University, Chicago, and the Department of Medicine (G.G.), the Division of Infectious Diseases (A.R.), the Division of Microbiology (R.B.T., L.R.P.), and the Center on Outcomes, Research, and Education (J.L.B.), NorthShore University HealthSystem, Evanston, Illinois.

Objective.

We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.

Design.

Retrospective cohort study. Setting and intervention. Three hospitals with universal surveillance for MRSA; at their physician's discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice daily, plus chlorhexidine gluconate 4% every second day. Patients and methods. MRSA carriers were later retested for colonization (407 subjects; study 1) or followed up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA infection (in study 2).

Results.

Independent risk factors for sustained colonization included residence in a long-term care facility (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.1-3.2]) and a pressure ulcer (OR, 2.3 [95% CI, 1.2-4.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy; mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6-10.7]). Over a median follow-up duration of 269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0-1.4]), chronic lung disease (HR, 1.7 [95% CI, 1.0-2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1-3.1]). Receipt of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among patients receiving mupirocin (median time to infection, 50 vs 15.5 days; [Formula: see text]).

Conclusions.

Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization but did not decrease the risk of subsequent infection.

ChicagoJournals

Activity of the anti-MRSA carbapenem razupenem (PTZ601) against Enterobacteriaceae with defined resistance mechanisms.

Activity of the anti-MRSA carbapenem razupenem (PTZ601) against Enterobacteriaceae with defined resistance mechanisms.

J Antimicrob Chemother. 2009 Jun

Livermore DM, Mushtaq S, Warner M.
Antibiotic Resistance Monitoring & Reference Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, NW9 5EQ, UK.

Background

Razupenem (previously known as PTZ601, PZ-601, SMP-601 or SM-216601) is a novel carbapenem, active against Enterobacteriaceae as well as Gram-positive bacteria including methicillin-resistant staphylococci and enterococci.

Methods

We examined the effect of extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases on the activity of razupenem, using the CLSI agar dilution method to measure MICs for mutants, transconjugants and isolates with and without these enzymes.

Results

ESBLs had no effect on the activity of razupenem against Escherichia coli and Klebsiella spp., and only a small effect when coupled with outer membrane impermeability. Inducible or, more especially, derepressed AmpC enzymes gave some protection, with most AmpC-derepressed Enterobacter and Citrobacter spp. requiring MICs of approximately 8 mg/L. This relative resistance was further increased when porins were lost, restricting drug uptake. Metallo- and class A-carbapenemases conferred resistance, with MICs >/=16 mg/L.

Conclusions

Razupenem has good activity against ESBL producers, but is affected by AmpC enzymes, especially when derepressed and coupled with outer membrane impermeability; its activity is also compromised by carbapenemases.

OxfordJournals

Antimicrobial resistance profile of methicillin resistant staphylococcal aureus from skin and soft tissue isolates.

Antimicrobial resistance profile of methicillin resistant staphylococcal aureus from skin and soft tissue isolates.
J Pak Med Assoc. 2009 May

Idrees F, Jabeen K, Khan MS, Zafar A.
Department of Pathology & Microbiology, Aga Khan University Hospital, Karachi, Pakistan.

OBJECTIVES: To evaluate resistance rates in methicillin resistant Staphylococcus aureus (MRSA) against clindamycin, cotrimoxazole, tetracycline, fusidic acid, rifampicin and chloramphenicol isolated from skin and soft tissue infections (SSTI). METHODS: Descriptive analysis of SSTI samples yielding MRSA in clinical laboratory of a tertiary care center; receiving specimens across Pakistan from January 2005 to June 2007.

MICROBIOLOGICAL METHODS: MRSA were identified using standard microbiological techniques. Susceptibility testing was performed by disc diffusion according to Clinical Laboratory Standards Institute (CLSI) against fusidic acid, tetracycline, cotrimoxazole, clindamycin, rifampicin and chloramphenicol. Minimum inhibitory concentrations (MIC) of rifampicin were determined using agar dilution method according to CLSI.

RESULTS: During the study period 501 MRSA were isolated from SSTI. Overall variable susceptibility pattern with high resistance rates to tetracycline (82%), clindamycin (79%), cotrimoxazole (59%), and rifampicin (50%) were observed. Resistance to chloramphenicol (10%) and fusidic acid (9%) was low.

CONCLUSION: There is a strong need in resource limited countries to review the utility of conventional antibiotics for the management of MRSA SSTI as new agents are expensive and not available. High resistance rates were observed against cotrimoxazole, tetracycline and clindamycin. Resistance to fusidic acid, rifampicin and Chloramphenicol was low.

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry?

Methicillin-resistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry?
Clin Oral Investig. 2008 Dec 23

Zimmerli M, Widmer AF, Dangel M, Filippi A, Frei R, Meyer J.
Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basel, Basel, Switzerland.

We assessed the frequency of carriers of methicillin-resistant Staphylococcus aureus (MRSA) among 500 dental patients of a university clinic. From each participant, two specimens were taken from the anterior nares and the pharynx and analysed by culture. The participants completed a questionnaire on possible risk factors of MRSA infection. Two hundred ten individuals carried S. aureus, 90 in the nares only, 51 in the throat only and 69 in nares and throat. Isolates of 208 patients were methicillin-sensitive; two isolates were methicillin-resistant, both carried in the throat exclusively. In conclusion, the frequency of nasal and/or throat carriers of MRSA among dental patients was low and suggests few opportunities of exposure in the dental clinic assessed.

SpringerLink

Methicillin-Resistant Staphylococcus aureau Infections

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

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

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]