Abstract
BackgroundMethicillin resistant Staphylococcus aureus (MRSA) has been considered for many years a typical nosocomial pathogen. Recently MRSA has emerged as a frequent cause of infections in the community. More commonly, community-acquired (CA)-MRSA is a cause of infections of the skin and soft-tissues, but life-threatening infections such as necrotizing pneumonia and sepsis can occasionally occur.Case presentationThis report describes an uncommon presentation of invasive CA-MRSA infection in an adolescent without known risk factors. The presentation was typical for bacterial meningitis, but the clinical findings also revealed necrotizing pneumonia. Following the development of deep venous thrombosis, the presence of an inherited trombophilic defect (factor V Leiden) was detected. The patient was successfully treated with an antibiotic combination including linezolid and with anticoagulant therapy. CA-MRSA was isolated from both cerebrospinal fluid and blood. The isolates were resistant to oxacillin and other beta-lactam antibiotics and susceptible to the other antibiotics tested including erythromycin. Molecular typing revealed that the strains contained the Panton-Valentine leukocidin genes and type IV SCCmec, and were ST8, spa type t008, and agr type 1. This genetic background is identical to that of the USA300 clone.ConclusionThis report highlights that meningitis can be a new serious presentation of CA-MRSA infection. CA-MRSA strains with the genetic background of the USA300 clone are circulating in Italy and are able to cause severe infections.
Highlights
Methicillin resistant Staphylococcus aureus (MRSA) has been considered for many years a typical nosocomial pathogen
This report highlights that meningitis can be a new serious presentation of CA-MRSA infection
CA-MRSA strains with the genetic background of the USA300 clone are circulating in Italy and are able to cause severe infections
Summary
The development of a serious infection in a young person without predisposing conditions is a typical feature of CAMRSA infections. In the USA, an increasing number of bloodstream infections in hospitalized patients is due to typical PVL-positive CA-MRSA [22], probably reflecting the introduction of the USA300 clone in the health-care setting in that country. Another remarkable feature of this case is the association of the invasive CA-MRSA infection with deep venous thrombosis (DVT). Since the vancomycin MIC of the isolate was at the breakpoint for susceptibility (2 μg/ml) and the patient's condition remained critical, a different antibiotic combination including linezolid was started. This case adds a new clinical presentation to CA-MRSA infections and highlights the problems encountered in the choice of the therapy of serious community-acquired infections in the CA-MRSA era
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