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

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

SciELO

MRSA Associated with Acupuncture and Joint Injection

Outbreak of Invasive Methicillin-Resistant Staphylococcus aureus Infection Associated With Acupuncture and Joint Injection.
August 2008

Murray RJ, Pearson JC, Coombs GW, Flexman JP, Golledge CL, Speers DJ, Dyer JR, McLellan DG, Reilly M, Bell JM, Bowen SF, Christiansen KJ.

From the Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Royal Perth Hospital (R.J.M., J.C.P., G.W.C, J.P.F., K.J.C.), the Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Queen Elizabeth II Medical Centre (C.L.G., D.J.S.), the Infectious Diseases Department (J.R.D., D.G.M.) and the Communicable Diseases Control Directorate, Western Australian Department of Health (S.F.B), Western Diagnostic Pathology (D.G.M), and Hands-On Infection Control (M.R.), West Perth, Perth, Western Australia , and the Department of Microbiology and Infectious Diseases, Women's and Children's Hospital, Adelaide, South Australia (J.M.B) , Australia . (Present affiliation: Clinical Services, Fremantle Hospital and Health Services, Perth, Western Australia, Australia [S.F.B.].).

Objective. To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner.

Setting. A medical practitioner's office and 4 hospitals in Perth, Western Australia.

Patients. Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner.

Methods. We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner.

Results. Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified.

Conclusions. This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.

Infection Control & Hospital Epidemiology

Prevention of MRSA: what hygienic measures are meaningful?]

Prevention of MRSA: what hygienic measures are meaningful?
Anasthesiol Intensivmed Notfallmed Schmerzther. 2008 Jul
Kerwat K, Wulf H.
Klinik für Anästhesie und Intensivtherapie/Universitätsklinikum Giessen und Marburg.

MRSA has become a major challenge for the health system. The proportion of MRSA in the total collective of Staphylococcus aureus cases in Germany amounts to about 35 %. The further spread of MRSA must be prevented or at least slowed down. There is controversial discussion about which hygienic measures are meaningful. In Germany most people and institutions attempt to follow the recommendations of the Robert Koch Institute. These recommendations include, among others, the isolation of MRSA patients. However, this measure can only be achieved with difficulty and has limited efficacy. It may even happen that MRSA patients are treated less effectively just on account of the isolation and the other extensive measures and may more frequently experience complications. Thus it must be considered whether or not better results would be obtained without isolation when the standard hygienic protocols are strictly observed.

Thieme Connect

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]