Methicillin-resistant Staphylococcus Aureus In Community Research Articles

Exploring the Antibacterial Potential of 2-Ethylacridine from Salacia chinensis: Insights into its Mechanism against Methicillin-Resistant Staphylococcus aureus (MRSA)

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a growing health issue in India, leading to higher healthcare costs and increased morbidity and mortality rates. The prevalence of MRSA in both community and hospital settings has been on the rise, necessitating the exploration of alternative treatments. Aim: This study aimed to isolate secondary metabolites from Salacia sinensis and determine their mode of action against MRSA through molecular docking. Methodology: The study involved the collection of plant samples from Tamil Nadu, India, and the extraction of phytochemicals using methanol and chloroform. GCMS analysis was conducted to identify the bioactive compounds, and molecular docking analysis was performed to assess the antibacterial activity of 2-Ethylacridine against the multi-drug resistance protein (nora) of S.aureus. Results: The qualitative phytochemical screening of S. chinensis extracts revealed the presence of proteins, carbohydrates, flavonoids, saponins, sterols, terpenoids, and alkaloids. GCMS analysis identified bioactive compounds namely 2-Ethylacridine and Squalene. Molecular docking analysis demonstrated a high binding affinity (-6.8) of 2-Ethylacridine to the Multi-drug resistance protein (nora) of S.aureus. Implications: The study provides insights into the antibacterial mechanism of 2-Ethylacridine against MRSA, suggesting its potential as a promising antibacterial agent. These findings have implications for the development of novel antibacterial agents targeting multi drug resistance proteins and addressing antibiotic-resistant strains.

“Evaluation Of Several Phenotypic Methods Of Antibiotic Susceptibility Pattern For The Detection Of MRSA With Molecular Profiling RT-PCR With The Detection Of MecA Gene”

INTRODUCTION:- Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized public health problem throughout the world and community MRSA strains are now epidemic in India and others countries. The resistance rates of S. aureus infection and multidrug resistant strains are increasing, making the clinical anti-infective treatment and diagnosis more difficult.
 AIM:- To evaluate several phenotypic methods of the antibiotic susceptibility pattern for the detection of MRSA with Molecular Profiling Rt-PCR with the detection of MecA gene.
 MATERIALS AND METHODS:- The present study was a prospective observational study carried out at the Department of Microbiology, Santosh Medical College, Ghaziabad in a tertiary care hospital over a 12-month period from August 1, 2020 to July 31, 2021. Both IPD and OPD clinical sample comprised 385 clinical isolates as Staphylococcus aureus from various clinical specimens were included. Antibiotic susceptibility by the Kirby-Baure disc diffusion methods was performed according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Detection of MRSA by various methods like, Cefoxitin Disk diffusion Method, Oxacillin Disk diffusion method, E-Test method and detection of MecA gene by RT-PCR was carried out.
 RESULT:- In the present study out of 384 clinical samples, the majority of isolates from MRSA were found to be resistant to (E-Test) strip Oxacillin 114 (29.7%), followed by cefoxitin 113 (29.4%) and disc diffusion oxacillin 99 (25.8%). However, we observed a high incidence of resistance to other antibiotics such as Erythromycin 265 (69.0%), followed by Clotrimozole 228 (59.4%), Tetracyclin 144 (37.5), Vancomycin 102 (26.6%) and Refampicin 102 (26.6%). We also observed that Linezolid 354 (92.2%) followed by Teicoplanin 325 (84.6%), Gentamycin 272 (70.8%), Clindamycin 249 (64.8%) and Amoxyclave 281 (73.2%). In this study molecular RT-PCR test for the detection of mecA gene observed more in pus with 36 samples out of 113 followed by blood 17, urine 33, Sputum 05, pleural fluid 04, wound swab 16, Vaginal swab 06, CSF 01, Throat swab 2.
 CONCLUSION:- The gold standard assay for determining methicillin resistance is the PCR technique for detecting the mecA gene. But Because PCR is still time intensive and expensive, and it is not yet available in the 95% of routine clinical laboratories the phenotypic methods is still the choice where E-test is more reliable method than the disc diffusion method in detecting the drug resistance and can be utilised on a regular basis for better results.

A facile and general method for synthesis of antibiotic-free protein-based hydrogel: Wound dressing for the eradication of drug-resistant bacteria and biofilms.

Antibacterial protein hydrogels are receiving increasing attention in the aspect of bacteria-infected-wound healing. However, bacterial drug resistance and biofilm infections lead to hard healing of wounds, thus the construction of biological agents that can overcome these issues is essential. Here, a simple and universal method to construct antibiotic-free protein hydrogel with excellent biocompatibility and superior antibacterial activity against drug-resistant bacteria and biofilms was developed. The green industrial microbicide tetrakis (hydroxymethyl) phosphonium sulfate (THPS) as cross-linking agent can be quickly cross-linked with model protein bovine serum albumin (BSA) to form antibacterial hydrogel through simple mixing without any other initiators, subsequently promoting drug-resistance bacteria-infected wound healing. This simple gelatinization strategy allows at least ten different proteins to form hydrogels (e.g. BSA, human serum albumin (HSA), egg albumin, chymotrypsin, trypsin, lysozyme, transferrin, myohemoglobin, hemoglobin, and phycocyanin) under the same conditions, showing prominent universality. Furthermore, drug-resistance bacteria and biofilm could be efficiently destroyed by the representative BSA hydrogel (B-Hydrogel) with antibacterial activity, overcoming biofilm-induced bacterial resistance. The in vivo study demonstrated that the B-Hydrogel as wound dressing can promote reepithelization to accelerate the healing of methicillin-resistant staphylococcus aureus (MRSA)-infected skin wounds without inducing significant side-effect. This readily accessible antibiotic-free protein-based hydrogel not only opens an avenue to provide a facile, feasible and general gelation strategy, but also exhibits promising application in hospital and community MRSA disinfection and treatment.

Nasal colonization with methicillin-resistant Staphylococcus aureus associated with elevated homocysteine levels in the general US adults.

Given the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) as a global health threat, understanding the risk factors for MRSA infection in the community may be a reasonable strategy to prevent it. We investigated the associations between serum homocysteine levels and prevalence of nasal colonization with S aureus and MRSA among United States adults. We conducted a cross-sectional analysis of a nationally representative sample of 7832 adults (20 years or older). The main outcome variables were nasal colonization with S aureus and MRSA. Percentages of colonization with S aureus and MRSA were calculated by the quartiles of serum homocysteine. A total of 7832 of 2051 subjects (26.2%) were culture positive for S aureus, 98 (4.8%) of whom had nasal colonization with MRSA. In comparison with subjects having the lowest serum homocysteine, the odds of nasal colonization with MRSA were significantly higher in those with the highest homocysteine (odds ratio, 3.09; 95% confidence interval, 1.11–8.61) in multivariate analysis, adjusted for all confounding variables. By contrast, homocysteine elevation was not significantly associated with S aureus colonization. Nasal colonization with MRSA in the general community was significantly associated with increases in serum homocysteine levels.

Nasal colonization of Methicillin resistant Staphylococcus aureusamong patients during hospital admission--emergence of community-associated MRSA strains

Patients colonized with Methicillin resistant Staphylococcus aureus (MRSA) in hospital are considered as one of the risk factors for infection with MRSA. Worldwide spread of MRSA in both hospital setting and community poses public health threat. This study was undertaken to determine the frequency of MRSA colonization among patients at time of hospital admission. Five hundred adult patients were screened within 24 hrs of admission in different wards in Dhaka Medical College Hospital by taking nasal swabs from anterior nares and were analyzed. All isolated Staphylococcusaureus were screened to detect methicillin resistance by modified Kirby-Bauer disc diffusion method using oxacillin and cefoxitin disc and then all MRSA isolates were subjected for MIC testing against oxacillin by agar dilution method and PCR for mecAgene detection. Out of 500 patients Staph aureus nasal colonization was observed among 112 (22.4%) patients and among those 7.6% was MRSA.MRSA colonization rate was 23.29% among patients who had history of prior hospitalization and was 4.92% among community residents who had no previous hospitalization history in last 12 month. A significant number of patients (7.6%) were colonized with MRSA at the time of admission. Screening for MRSA carriers among this population is necessary for hospital acquired infection control.Bangladesh J Med Microbiol 2014; 08 (02): 08-13

Evaluation of tigecycline activity on wound isolates of methicillinresistant Staphylococcus aureus from hospital and communityacquired infections in Cross River State, Nigeria

Background/Objective: Tigecycline belongs to the glycylcycline class of antibiotics with in-vitroactivity against most gram-positive bacteria, including multidrug-resistant pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) is one of such pathogen, which has been associated with community and hospital-acquired infections. Tigecycline is considered to be a newer treatment option for emerging multidrug-resistant bacteria. This study aims to determine the in-vitro activity of tigecycline against community and hospital-acquired MRSA isolated from infected traumatic wounds in Cross River State. Material and Methods: A total of 60 MRSA were isolated from wound samples, 30 each from the community and hospital settings. These were tested for tigecycline susceptibility by the E-test method. Detection of methicillin resistance was performed using cefoxitin (30µg) disk. All strains were identified according to standard bacteriological methods. Results: Of the 60 isolates, 55 (91.7%) were sensitive to tigecycline with MIC50 and MIC90 values of 0.25 and 0.5μg/ml, respectively. Twenty-seven (90.0%) of the 30 community-acquired isolates were susceptible to tigecycline, while 28 (93.3%) of the 30 hospital-acquired isolates were susceptible. Conclusions: Tigecycline showed excellent in-vitro activity against MRSA wound isolates and, therefore may be a drug of choice for empirical therapy of skin and soft tissue infections in areas where MRSA is prevalent.

Comparing the epidemiology of hospital-acquired methicillin-resistant Staphylococcus aureus clone groups in Alberta, Canada.

Patients with methicillin-resistant Staphylococcus aureus (MRSA) clones, which were traditionally seen in the community setting (USA400/CMRSA7 and USA300/CMRSA10), are often identified as hospital-acquired (HA) infections using Infection Prevention and Control (IPC) surveillance definitions. This study examined the demographics and healthcare risk factors of patients with HA-MRSA to help understand if community MRSA clones are from a source internal or external to the hospital setting. Despite USA300/CMRSA10 being the predominant clone in Alberta, hospital clones (USA100/CMRSA2) still dominated in the acute care setting. In the Alberta hospitalized population, patients with USA400/CMRSA7 and USA300/CMRSA10 clones were significantly younger, had fewer comorbidities, and a greater proportion had none or ambulatory care-only healthcare exposure. These findings suggest that there are two distinct populations of HA-MRSA patients, and the patients with USA400/CMRSA7 and USA300/CMRSA10 clones identified in hospital more greatly resemble patients affected by those clones in the community. It is possible that epidemiological assessment overidentifies HA acquisition of MRSA in patients unscreened for MRSA on admission to acute care.

Being Met as marked - patients' experiences of being infected with community-acquired methicillin-resistant Staphylococcus aureus (MRSA).

It is known that patients who acquired methicillin-resistant Staphylococcus aureus (MRSA) in hospitals suffer and feel as plague. Moreover, the patient interaction with nurses and physicians is described as frightening. Little is known about patient experiences after having acquired CA-MRSA concerning care and everyday life. To reveal and interpret otherwise healthy patients' lived experiences of receiving care and their everyday life after having acquired community MRSA (CA-MRSA). A phenomenological hermeneutic approach guided by Ricouer was conducted. Interviews with twelve patients were transcribed verbatim into a text. The text was analysed in three phases: naive understanding, structural analysis and comprehensive understanding to reveal a possible being in the world. In this study, this referred to what it means to be infected with CA-MRSA. The findings indicate that patients who acquired MRSA experience a changed body image. They suffer from ignorant and frightened behavior from healthcare workers, social contacts, and also of being bullied by colleagues. Despite this, patients assume great responsibility for protecting others. However, knowledgeable staff alleviate suffering and bring peace of mind to the patients. Preventing patient's feelings of being a pest, an outsider living with fear, requires urgent education and understanding about resistant bacteria and how to meet an infected patient. The results describing patients, affected with MRSA, may contribute and touch the readers to better understanding of patient's changed body image and suffering and how to mitigate these feelings.

MRSA in Croatia: prevalence and management

ABSTRACTInfections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with increased morbidity, mortality and length of hospital stay. MRSA is a major pathogen in hospitals and an important pathogen in community infections with few severe and fatal cases. However, MRSA causes the majority of skin and soft tissue infections in the US. The burden of community MRSA is much smaller in Europe, but there are reports of livestock-associated MRSA (LA-MRSA) isolated from pigs and cattle causing significant infections in the people who are connected to these farms. MRSA has been present in Croatia for more than 45 years, and it exerts a different impact on health-care infections. A remarkable increase in MRSA percentage was noted in primarily sterile samples in 2002 (37%) in comparison to 2001 (31%). This percentage remained quite high until 2008, when the first signs of a reduced trend were observed. The lowest percentage was 22% in 2012.

Impact of target site distribution for Type I restriction enzymes on the evolution of methicillin-resistant Staphylococcus aureus (MRSA) populations

A limited number of Methicillin-resistant Staphylococcus aureus (MRSA) clones are responsible for MRSA infections worldwide, and those of different lineages carry unique Type I restriction-modification (RM) variants. We have identified the specific DNA sequence targets for the dominant MRSA lineages CC1, CC5, CC8 and ST239. We experimentally demonstrate that this RM system is sufficient to block horizontal gene transfer between clinically important MRSA, confirming the bioinformatic evidence that each lineage is evolving independently. Target sites are distributed randomly in S. aureus genomes, except in a set of large conjugative plasmids encoding resistance genes that show evidence of spreading between two successful MRSA lineages. This analysis of the identification and distribution of target sites explains evolutionary patterns in a pathogenic bacterium. We show that a lack of specific target sites enables plasmids to evade the Type I RM system thereby contributing to the evolution of increasingly resistant community and hospital MRSA.

Impact of an enhanced antibiotic stewardship on reducing methicillin-resistant Staphylococcus aureus in primary and secondary healthcare settings

The objective of this study was to evaluate the impact of restricting high-risk antibiotics on methicillin-resistant Staphylococcus aureus (MRSA) incidence rates in a hospital setting. A secondary objective was to assess the impact of reducing fluoroquinolone use in the primary-care setting on MRSA incidence in the community. This was an interventional, retrospective, ecological investigation in both hospital and community (January 2006 to June 2010). Segmented regression analysis of interrupted time-series was employed to evaluate the intervention. The restriction of high-risk antibiotics was associated with a significant change in hospital MRSA incidence trend (coefficient=-0·00561, P=0·0057). Analysis showed that the intervention relating to reducing fluoroquinolone use in the community was associated with a significant trend change in MRSA incidence in community (coefficient=-0·00004, P=0·0299). The reduction in high-risk antibiotic use and fluoroquinolone use contributed to both a reduction in incidence rates of MRSA in hospital and community (primary-care) settings.

Diversity of Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Isolated from Inpatients of 30 Hospitals in Orange County, California

There is a need for a regional assessment of the frequency and diversity of MRSA to determine major circulating clones and the extent to which community and healthcare MRSA reservoirs have mixed. We conducted a prospective cohort study of inpatients in Orange County, California, systematically collecting clinical MRSA isolates from 30 hospitals, to assess MRSA diversity and distribution. All isolates were characterized by spa typing, with selective PFGE and MLST to relate spa types with major MRSA clones. We collected 2,246 MRSA isolates from hospital inpatients. This translated to 91/10,000 inpatients with MRSA and an Orange County population estimate of MRSA inpatient clinical cultures of 86/100,000 people. spa type genetic diversity was heterogeneous between hospitals, and relatively high overall (72%). USA300 (t008/ST8), USA100 (t002/ST5) and a previously reported USA100 variant (t242/ST5) were the dominant clones across all Orange County hospitals, representing 83% of isolates. Fifteen hospitals isolated more t008 (USA300) isolates than t002/242 (USA100) isolates, and 12 hospitals isolated more t242 isolates than t002 isolates. The majority of isolates were imported into hospitals. Community-based infection control strategies may still be helpful in stemming the influx of traditionally community-associated strains, particularly USA300, into the healthcare setting.

Mupirocin resistance in clinical isolates ofStaphylococcus aureusin a tertiary care hospital set up in North India

Background: Mupirocin is a topical antibiotic used for nasal decolonisation of methicillin resistant Staphylococcus aureus (MRSA). While resistance to mupirocin has been described it is usually not tested for in most clinical laboratories. Aim: The present study was carried out to detect the occurrence of mupirocin resistance in clinical isolates of Staphylococcus aureus in a tertiary care hospital set up in northern India. Materials and Methods: Staphylococcus aureus isolates obtained from clinical samples received in the microbiology laboratory over a period of one year were included in this study. Mupirocin resistance was detected by three phenotypic methods; disk diffusion method using 5μg and 200μg mupirocin disk to determine low-level and high-level resistance, broth microdilution method and an agar dilution method for determining minimum inhibitory concentrations. Methicillin sensitivity was also determined in the study isolates. Results: Of 250 non-duplicate Staphylococcus aureus isolates obtained, 5 (2%) were found resistant to mupirocin. All mupirocin resistance isolates were shown to have high-level resistance (minimum inhibitory concentration > 512μg/ml). All mupirocin resistant isolates were also resistant to methicillin. Results obtained by all three phenotypic methods showed good correlation. Conclusion: High-level mupirocin resistance is present in the northern Indian population which may be of major concern to prevent the spread of MRSA in hospitals and community.

Prevalence and characteristics of community carriage of methicillin-resistant Staphylococcus aureus in Malta

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. Malta is one of the countries with the highest MRSA prevalence in Europe, as identified from hospital blood cultures [1]. However, community prevalence of MRSA has never previously been investigated. This study aimed at establishing the prevalence of community MRSA nasal colonization in Maltese individuals and identifying the clonal characteristics of the detected isolates. Nasal swabs were collected from 329 healthy individuals who were also asked to complete a brief questionnaire about risk factors commonly associated with MRSA carriage and infection. The swabs were transported and enriched in a nutrient broth supplemented with NaCl. The presence of MRSA was then determined by culturing on MRSA Select chromogenic agar and then confirming by several assays, including catalase, coagulase and PBP2a agglutination tests. The isolates were assayed for antibiotic susceptibilities and typed by microarray analysis to determine the clonal characteristics of each strain. The prevalence of MRSA nasal colonization in the healthy Maltese population was found to be 8.81% (95% confidence interval [CI], 5.75–11.87%), much higher than that found in other studies carried out in several countries. No statistical association was found between MRSA carriage and demographics or risk factors; however, this was hindered by the small sample size. Almost all the isolates were fusidic-acid resistant. The majority were found to belong to a local endemic clone (CC5) which seems to be replacing the previously prevalent European clone UK-EMRSA-15 in the country. A new clone (CC50-MRSA-V) was also characterized. The presence of such a significant community reservoir of MRSA increases the burdens already faced by the local healthcare system to control the MRSA epidemic. Colonization of MRSA in otherwise healthy individuals may represent a risk for endogenous infection and transmission to hospitalized patients after admission to a healthcare facility, leading to longer hospital stays and, consequently, increased healthcare costs.

Isolation and identification of methicillin-resistant Staphylococcus aureus from students’ coins

Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen of increasing risk on community. This study aims at determining the risk of MRSA transfer from coins as silent and underestimated reservoir in community. One hundred swabs from coins were collected from college students in Malaysia. A series of identification and differentiating tests were conducted for precise identification of MRSA bacteria. Moreover, this study compared the efficacy of the different identification tests with gold standard, polymerase chain reaction (PCR) assay. The tests used were tube coagulase, DNase agar test, antibiogram, several routine biochemical identification tests and PCR assays. PCR assay used specific primers for resistance or ID -related genes: mecA, ermA, ermB, ermC, msrA, linA, femA, and nuc genes. A total of 37 bacterial isolates were isolated from college students’ coins; non-PCR assays of identification and resistance detection revealed the presence and spread of MRSA in coins of 2 college students. PCR-amplification of the nuc gene was used as a baseline test to detect S. aureus. PCR showed only one isolate as true MRSA. False positive MRSA by disc diffusion assay might be attributed to low pH and high thymidine content of Muller Hinton agar medium. Collectively, coins proved to be possible source for the transfer of MRSA in community of college students in South East Asia. Moreover, PCR assay for identification of S. aureus resistance proved to be superior on other methods. Key words : Staphylococcus aureus , MRSA, nail, PCR, resistance.

Molecular and Phenotypic Characteristics of Healthcare- and Community-Associated Methicillin-Resistant Staphylococcus aureus at a Rural Hospital

BackgroundWhile methicillin-resistant Staphylococcus aureus (MRSA) originally was associated with healthcare, distinct strains later emerged in patients with no prior hospital contact. The epidemiology of MRSA continues to evolve.MethodsTo characterize the current epidemiology of MRSA-colonized patients entering a hospital serving both rural and urban communities, we interviewed patients with MRSA-positive admission nasal swabs between August 2009 and March 2010. We applied hospitalization risk factor, antimicrobial resistance phenotype, and multi-locus sequence genotype (MLST) classification schemes to 94 case-patients.ResultsBy MLST analysis, we identified 15 strains with two dominant clonal complexes (CCs)–CC5 (51 isolates), historically associated with hospitals, and CC8 (27 isolates), historically of community origin. Among patients with CC5 isolates, 43% reported no history of hospitalization within the past six months; for CC8, 67% reported the same. Classification by hospitalization risk factor did not correlate strongly with genotypic classification. Sensitivity of isolates to ciprofloxacin, clindamycin, or amikacin was associated with the CC8 genotype; however, among CC8 strains, 59% were resistant to ciprofloxacin, 15% to clindamycin, and 15% to amikacin.ConclusionsHospitalization history was not a strong surrogate for the CC5 genotype. Conversely, patients with a history of hospitalization were identified with the CC8 genotype. Although ciprofloxacin, clindamycin, and amikacin susceptibility distinguished CC8 strains, the high prevalence of ciprofloxacin resistance limited its predictive value. As CC8 strains become established in healthcare settings and CC5 strains disseminate into the community, community-associated MRSA definitions based on case-patient hospitalization history may prove less valuable in tracking community MRSA strains.

Predicting methicillin resistance among community-onset Staphylococcus aureus bacteremia patients with prior healthcare-associated exposure

To develop and validate prediction rules to identify the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among community patients who have healthcare-associated (HA) exposure and S. aureus bacteremia. A total of 1,166 adults with community-onset S. aureus bacteremia were retrospectively enrolled. The background prevalence of community MRSA infection was extrapolated from 392 community-associated S. aureus bacteremia (CA-SAB) patients without HA exposure. Complete and clinical risk scores were derived and tested using data from 774 healthcare-associated S. aureus bacteremia (HA-SAB) patients. The risk scores were modeled with and without incorporating previous microbiological data as a model predictor and stratified patients to low-, intermediate-, and high-risk groups for MRSA infection. The clinical risk score included five independent predictors and the complete risk score included six independent predictors. The clinical and complete risk scores stratified 32.7 % and 42.0 % of HA-SAB patients to the low-risk group for MRSA infection respectively. The prevalence of MRSA infection in score-stratified low-risk groups ranged from 16.3 % to 23.3 %, comparable to that of CA-SAB patients (13.8 %). Simple decision rules allow physicians to stratify the risk of MRSA infection when treating community patients with prior HA exposure and possible S. aureus infection.

Managing Severe Community-Acquired Pneumonia Due to Community Methicillin-Resistant Staphylococcus aureus (MRSA)

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is a rare, but significant cause of community-acquired pneumonia (CAP). A number of virulence determinants have been implicated in the development of severe community MRSA pneumonia, characterized by multilobar cavitating necrosis in patients without usual risk-factors for pneumonia. Optimal management is uncertain, and is extrapolated from anecdotal experiences with small case series, randomized studies of hospital-acquired pneumonia, and laboratory investigations using in vitro experiments and animal models of MRSA pneumonia. Adequate clinical suspicion, early diagnosis and administration of appropriate antibiotics are necessary for best patient outcomes, although some patients will still do badly even with early anti-MRSA therapy. Vancomycin or linezolid have been recommended as first-line therapy, possibly in combination with other antibiotics. Newer antibiotics such as ceftaroline are still being evaluated.

Not Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA)! A Clinician's Guide to Community MRSA - Its Evolving Antimicrobial Resistance and Implications for Therapy

There is significant diversity in methicillin-resistant Staphylococcus aureus (MRSA) clones arising in the community worldwide, with considerable geographical differences in typical antimicrobial resistance profiles. Many community clones of MRSA have a non-multidrug resistant antimicrobial profile, providing increased options for empirical and directed therapy of infections caused by these strains. However, the recent description of increasing non-β lactam resistance in community clones of MRSA, especially USA300, provides a timely warning for clinicians making decisions about therapy for patients potentially infected with these strains. Continued monitoring of global epidemiology and emerging drug resistance data is critical for the effective management of these infections.

Exposure of emergency medical responders to methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) infections result in 19,000 deaths a year in the United States. Epidemiologic studies have shown that community-acquired infections are increasing dramatically, and strains typical of community infections are increasingly detected in hospital populations. Emergency medical responders (EMR) are exposed to both community and hospital MRSA patients, which, combined with their communal lifestyles in fire stations, results in higher risk of exposure. This study determined the occurrence and frequency of MRSA and other bacterial indicators on environmental surfaces in fire stations, training sites, and offices of EMR. Handled sponges were used for collection of targeted bacteria from commonly contacted environmental surfaces at EMR facilities. Biochemical tests confirmed isolates as S aureus, and MRSA was confirmed by growth on selective and differential media. An initial set of 500 samples was collected at 9 fire-related facilities to identify areas of increased exposure. Subsequent studies targeted sites (n = 160) for repeat sampling that were MRSA positive. S aureus was isolated from 10.6% (17/160) of the sampled sites. The couch and the classroom desks were the most contaminated at 20% (4/20 and 2/10, respectively). Of the S aureus isolated, 64.7% (11/17) were confirmed as MRSA. EMR have a high potential for exposure to MRSA, not only through patient and hospital contacts but also in the fire station environment. MRSA was isolated with the highest frequency on the couches and the class desks. Although the true health significance of these exposures is unknown, improved infection control practices, such as routine handwashing and surface disinfection, are warranted to reduce MRSA exposures.