Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) displays a remarkable array of resistance and virulence factors, which have contributed to its prominent role in infections of the critically ill. We are beginning to understand the function and regulation of some of these factors and efforts are ongoing to better characterize the complex interplay between the microorganism and host response. It is important that clinicians recognize the changing resistance patterns and epidemiology of Staphylococcus spp., as these factors may impact patient outcomes. Community-associated MRSA clones have emerged as an increasingly important subset of Staphyloccocus aureus and MRSA can no longer be considered as solely a nosocomial pathogen. When initiating empiric antibiotics, it is of vital importance that this therapy be timely and appropriate, as delays in treatment are associated with adverse outcomes. Although vancomycin has long been considered a first-line therapy for serious MRSA infections, multiple concerns with this agent have opened the door for existing and investigational agents demonstrating efficacy in this role.
Highlights
Methicillin-resistance in Staphylococcus species is encoded via the mecA gene, which results in production of penicillinbinding protein (PBP)2A, a penicillin binding protein with reduced affinity for β-lactams [1]. mec is part of a larger genomic element termed the Staphylococcal chromosomal cassette (SCCmec), which contains genes mediating antibiotic resistance
It has been observed that CA-Methicillin-resistant Staphylococcus aureus (MRSA) is effectively integrating into the health care environment and it is increasingly less reliable to make this differentiation on the basis of acquisition location [4,5,6,7]
Linezolid is recommended as an alternative agent for catheter-related blood stream infections (CRBSIs) due to MRSA in this same guideline [52]
Summary
MRSA will continue to be an important infection in the ICU setting for the foreseeable future. Clinicians should be aware of the changing virulence patterns and antimicrobial susceptibility patterns of MRSA in their local areas. This information should be used to develop prevention and treatment strategies aimed at minimizing patient morbidity and healthcare costs related to MRSA infections
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