Methicillin-Resistant Staphylococcus aureus Infections in Collegiate Football Players.

Methicillin-Resistant Staphylococcus aureus Infections in Collegiate Football Players.
Med Sci Sports Exerc. 2008 Jul 8

Bowers AL, Huffman GR, Sennett BJ.
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a serious skin infection in the athletic population. Literature in reference to football players has been sparse. We sought to better elucidate circumstances surrounding such infections in collegiate football players.

METHODS: Data from three Division-I collegiate football programs were consolidated and analyzed. Variables included presence of MRSA infection, timing of occurrence, body location involved, lesion morphology, need for surgical treatment, and antibiotic route. Data were analyzed statistically to evaluate player position, body location, and timing of occurrences.

RESULTS: Of the 491 collegiate football players, 33(6.7%) were diagnosed with MRSA infections. Cutaneous manifestations included abscess (70%), cellulitis (16%), folliculitis, impetigo, and necrotizing fasciitis. Of the infections, 90% underwent surgical drainage, whereas 27% received intravenous antibiotics. Extremity infections (n = 30) greatly exceeded truncal infections (n = 7); the most common locations were the elbow(n = 11), knee (n = 6), leg (n = 4), and forearm (n = 4). There was no difference in occurrence by player position. Infectionsoccurred predominantly in the first third of the season (P less than 0.001, chi-square test) and significantly decreased as the season progressed.

CONCLUSION: MRSA infections involving football players are becoming more common. This study documents player positions involved, timing of occurrence in the season, location and type of infections, and required treatment. Exposed extremities may predispose to infection due to risk for minor trauma and direct contact with bacteria. As infection risk seems to be independent of position, all players should observe protective measures. Although most infections occur earlier in the season, physicians should remain alert for infection occurrences throughout the season.

PubMed

Treatment of infective endocarditis caused by methicillin-resistant Staphylococcus aureus: Teicoplanin versus vancomycin in a retrospective study.

Treatment of infective endocarditis caused by methicillin-resistant Staphylococcus aureus: Teicoplanin versus vancomycin in a retrospective study.

Scand J Infect Dis. 2008

Huang JH, Hsu RB.
From the Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, ROC, Taiwan.

Infective endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA) is increasing. Vancomycin and teicoplanin are 2 intravenous glycopeptides appropriate for its treatment. There is no human study comparing teicoplanin and vancomycin for the treatment of MRSA endocarditis. Between 1996 and 2006, 51 MRSA endocarditis patients were treated at the authors' hospital. There were 29 patients with nosocomial infection; 15 were treated with teicoplanin. Teicoplanin was used as the first therapeutic agent in 3 patients because of renal insufficiency. Vancomycin was used as the first therapeutic agent in 12 patients. Treatment was changed to teicoplanin because of adverse reactions in 10 and persistent bacteremia in 2 patients. Early operation was performed in 2 patients because of persistent MRSA bacteremia. Overall, 7 patients died in hospital. There was no statistically significant difference in hospital mortality rate (42% vs 47%) and bacteriologic failure rate (34% vs 40%) between 36 patients treated with vancomycin and 15 patients treated with teicoplanin. Teicoplanin can be an alternative therapy of MRSA infective endocarditis.

Informaworld

A computational model of antibiotic-resistance mechanisms in Methicillin-Resistant Staphylococcus aureus (MRSA

A computational model of antibiotic-resistance mechanisms in Methicillin-Resistant Staphylococcus aureus (MRSA
J Theor Biol. 2008 Jun 4

Murphy JT, Walshe R, Devocelle M.
Modelling and Scientific Computing Group, School of Computing, Faculty of Engineering and Computing, Dublin City University, Glasnevin, Dublin 9, Ireland; Centre for Synthesis and Chemical Biology, Department of Pharmaceutical and Medicinal Chemistry, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.

An agent-based model of bacteria-antibiotic interactions has been developed that incorporates the antibiotic-resistance mechanisms of Methicillin-Resistant Staphylococcus aureus (MRSA). The model, called the Micro-Gen Bacterial Simulator, uses information about the cell biology of bacteria to produce global information about population growth in different environmental conditions. It facilitates a detailed systems-level investigation of the dynamics involved in bacteria-antibiotic interactions and a means to relate this information to traditional high-level properties such as the Minimum Inhibitory Concentration (MIC) of an antibiotic. The two main resistance strategies against beta-lactam antibiotics employed by MRSA were incorporated into the model: beta-lactamase enzymes, which hydrolytically cleave antibiotic molecules, and penicillin-binding proteins (PBP2a) with reduced binding affinities for antibiotics. Initial tests with three common antibiotics (penicillin, ampicillin and cephalothin) indicate that the model can be used to generate quantitatively accurate predictions of MICs for antibiotics against different strains of MRSA from basic cellular and biochemical information. Furthermore, by varying key parameters in the model, the relative impact of different kinetic parameters associated with the two resistance mechanisms to beta-lactam antibiotics on cell survival in the presence of antibiotics was investigated.

Elsevier Science Direct

Risk of Infection and Death due to Methicillin-Resistant Staphylococcus aureus in Long-term Carriers.

Risk of Infection and Death due to Methicillin-Resistant Staphylococcus aureus in Long-term Carriers.

Clin Infect Dis. 2008 Jun

Datta R, Huang SS.
1Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, and 2Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; 3Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut; and 4Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine.

Background: Patients with newly acquired methicillin-resistant Staphylococcus aureus (MRSA) have significant risks of short-term morbidity and mortality due to this pathogen. We were interested in assessing whether long-term carriers have persistent risks of disease and whether all carriers, regardless of the duration of carriage, should be considered to be reasonable candidates for interventions to reduce the risk of infection. Methods. We conducted a single-center retrospective cohort study to evaluate the risk of subsequent MRSA infection and death among patients known to have harbored MRSA for at least 1 year (i.e., prevalent carriers).

Results: Among 281 prevalent carriers, 65 (23%) developed a total of 96 discrete and unrelated MRSA infections in the year after their identification as prevalent carriers. The most common infections were pneumonia (accounting for 39% of MRSA infections), soft-tissue infection (14%), and central venous catheter infection (14%). Twenty-four percent of all infections involved bacteremia. Thirty-eight MRSA infections occurred during a new hospitalization, and 32 (84%) of these infections were the reason for admission to the hospital. MRSA contributed to 14 deaths, with 6 of these deaths deemed to be attributable to MRSA. Harboring MRSA for less then 2 and MRSA colonization at the time of detection as a prevalent carrier were predictive of subsequent infection with MRSA.

Conclusions: Individuals who are known to have harbored MRSA for greater 1 year are at high risk for subsequent MRSA morbidity and mortality and should be considered to be targets for intervention, in addition to individuals who have newly acquired this pathogen.

PMID: 18532892 [PubMed - as supplied by publisher]

Health-care workers: source, vector, or victim of MRSA?

Health-care workers: source, vector, or victim of MRSA?
Lancet Infect Dis. 2008 May
Albrich WC, Harbarth S.
Respiratory and Meningeal Pathogens Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa; Institute for Infectious Diseases, University Hospital Bern, Bern, Switzerland.

There is ongoing controversy about the role of health-care workers in transmission of meticillin-resistant Staphylococcus aureus (MRSA). We did a search of the literature from January, 1980, to March, 2006, to determine the likelihood of MRSA colonisation and infection in health-care workers and to assess their role in MRSA transmission. In 127 investigations, the average MRSA carriage rate among 33 318 screened health-care workers was 4.6%; 5.1% had clinical infections.

Risk factors included chronic skin diseases, poor hygiene practices, and having worked in countries with endemic MRSA. Both transiently and persistently colonised health-care workers were responsible for several MRSA clusters. Transmission from personnel to patients was likely in 63 (93%) of 68 studies that undertook genotyping. MRSA eradication was achieved in 449 (88%) of 510 health-care workers. Subclinical infections and colonisation of extranasal sites were associated with persistent carriage. We discuss advantages and disadvantages of screening and eradication policies for MRSA control and give recommendations for the management of colonised health-care workers in different settings.

PMID: 18471774 [PubMed - in process]

Real-time optical detection of methicillin-resistant Staphylococcus aureus using lytic phage probes.

Real-time optical detection of methicillin-resistant Staphylococcus aureus using lytic phage probes.

Biosens Bioelectron. 2008 Mar 18

Guntupalli R, Sorokulova I, Krumnow A, Pustovyy O, Olsen E, Vodyanoy V.
Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL 36849, United States.

Staphylococcus aureus (S. aureus)-specific bacteriophage was used as a probe for detection of methicillin-resistant S. aureus (MRSA) in aqueous solution using a novel optical method. Biorecognition phage monolayers transferred to glass substrates using Langmuir-Blodgett (LB) technique were exposed individually to MRSA in solution at logarithmic concentrations ranging from 10(6) to 10(9)cfu/ml, and observed for real-time binding using a CytoVivatrade mark optical light microscope system. Results indicate that LB monolayers possessed high levels of elasticity (K), measuring 22 and 29mN/m for 10(9) and 10(11)pfu/ml phage concentrations, respectively. Near-instantaneous MRSA-phage binding produced 33+/-5%, 10+/-1%, 1.1+/-0.1%, and 0.09+/-0.01% coverage of the substrate that directly correlated to a decrease in MRSA concentrations of 10(9), 10(8), 10(7), and 10(6)cfu/ml. The exclusive selectivity of phage monolayers was verified with Salmonella enterica subsp. enterica serovar typhimurium (S. typhimurium) and Bacillus subtilis.

PubMed

The Emergence of Mupirocin Resistance among Clinical Isolates of Methicillin-Resistant Staphylococcus aureus in Trinidad: a First Report.

The Emergence of Mupirocin Resistance among Clinical Isolates of Methicillin-Resistant Staphylococcus aureus in Trinidad: a First Report.

Jpn J Infect Dis. 2008 Mar

Orrett FA.
Unit of Pathology and Microbiology, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies. drfao4301@yahoo.com.

The objective of the study was to investigate the trend of mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) in Trinidad. No premarketing susceptibility surveillance was ever done following the introduction of mupirocin in 1986. A total of 188 MRSA strains recovered over a 2-year period from various body sites were tested for mupirocin resistance via the disc diffusion method. The major sources of MRSA were surgical site infections (74.0%) and bloodstream infections (8.0%). High-level and low-level mupirocin resistance were detected in 26.1 and 44.1% of MRSA stains, respectively. Resistances to other non-beta-lactam antibiotics were also high. Ninety-eight percent of all MRSA were resistant to erythromycin. This was followed by resistance rates of 96.8, 95.2, 94.1, 93.6, and 93.1%, for gentamicin, ciprofloxacin, amikacin and tobramycin, co-trimoxazole, and tetracycline, respectively. No MRSA strains were found to be resistant to vancomycin, linezolid, and quinupristin-dalfopristin. The study showed that mupirocin resistance among Trinidadian MRSA strains was relatively high compared to that seen in other countries. Because of the increasing prevalence of MRSA at the San Fernando General Hospital (SFGH) and the apparently increasing resistance to mupirocin, frequent monitoring of MRSA susceptibility patterns and infection control initiatives may be helpful in reducing the incidence of MRSA with a concomitant decrease in mupirocin resistance. This report is the first after 20 years of continuous use of the drug at the SFGH.

Japanese Journal of Infectious Disease