Prevalence Of Community-acquired Methicillin-resistant Staphylococcus Aureus Research Articles

2177. Characterization of community-acquired methicillin-resistant Staphylococcus aureus isolated from patients with skin and soft tissue infections in selected health facilities, in Kenya

Abstract Background Colonization of the skin, mucus membrane, and nose of humans by Staphylococcus aureus (S. aureus) is more common than infection. The lack of proper microbiological surveillance systems in Africa may underestimate the burden of Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), while little is known about its incidence. In Kenya, there is a paucity of data on prevalence and circulating CA-MRSA strains. Methods Cross-sectional study design was employed with a sample size of 228 wound swabs from community-acquired skin and soft tissue infections, collected from 5 AMR surveillance sites in Kenya. S. aureus isolation, identification, and antimicrobial susceptibility tests were carried out according to standard bacteriology methods. Molecular characterization for MRSA isolates was performed by whole genome sequencing. Results Descriptive and inferential statistics were computed using the R program. Total S. aureus isolated was 29.38 % while MRSA isolation varied within study sites, with a CA-MRSA prevalence of 1.8 %. Phenotypic resistance observed did not match genotypic resistance for some isolates. Resistance mostly reported in nosocomial infections and resistance to reserved antibiotics was observed, which raises concern. Mutations within resistance genes, Inducible-Macrolide-Lincosamide-Streptogramin b resistance (MLSBi), 23S ribosome resistance and also erythromycin resistance by efflux pump was observed. Staphylococcal chromosomal cassette mec (SCCmec) type IV was the most prevalent while the sequence types (STs) obtained were ST 30, 8 and the novel STs 7460 and 7635. Only one isolate had intact mecA and its regulatory genes, but still conferred methicillin resistance. IS 1272 was detected in mecA regulatory genes. Conclusion The resistance patterns observed in this study further highlight the burden of antimicrobial resistance in community isolates of S. aureus. There is need for more research on CA-MRSA within Antimicrobial resistance (AMR) surveillance in Kenya in order to better understand the molecular epidemiology as well as the drivers of resistance Disclosures All Authors: No reported disclosures

Trends in Panton-Valentine Leukocidin (PVL)-Positive Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in Outpatients of a University Hospital

The isolation frequency of strains with genetic features of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in inpatients. Additionally, the number of infectious diseases caused by Panton- Valentine leukocidin (PVL)-positive highly pathogenic MRSA strains has been increasing in communities. However, the prevalence of CA-MRSA strains in outpatients of hospitals is unknown. This study investigated the prevalence of CA-MRSA including PVL-positive MRSA strains among inpatients (n = 362) and outpatients (n = 184) between 2013 and 2017 at Tokai University Hachioji Hospital. The proportion of staphylococcal cassette chromosome (SCC) mec type IV, which is a major SCCmec type of CA-MRSA, increased significantly in inpatients (P < 0.01). In contrast, SCCmec type IV strains accounted for >50％ in outpatients every year. The isolation rate of PVL-positive MRSA strains in outpatients (12 strains, 6.5％) was significantly higher than that in inpatients (1 strain, 0.3％) (P < 0.01). Furthermore, the incidence of PVL-positive MRSA strains in 2016 to 2017 (8/70 strains, 11.4％) was significantly higher than that in 2013 to 2015 (4/114 strains, 3.5％) (P < 0.05). All PVL-positive MRSA strains were susceptible to minocycline, vancomycin, and linezolid. This study shows that the number of cases of PVL-positive MRSA strains is increasing in outpatients of a university hospital. Surveillance of PVL-positive MRSA strains for both inpatients and outpatients is necessary to prevent outbreaks of highly pathogenic MRSA strains.

Assessment of infections rate due to community-acquired Methicillin-resistant Staphylococcus aureus and evaluation of risk factors in the paediatric population.

We aimed at assessing the frequency of Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, identifying its risk factors and evaluating resistance patterns of Staphylococcus aureus to various antibiotics in order to recommend the optimal empirical treatment for suspected Staphylococcus aureus infections. We reviewed the medical records of children who were treated at Shaare Zedek medical centre, located in Jerusalem, Israel, over the years 2008-2019 and had a positive culture for Staphylococcus aureus. Patients with CA-MRSA infections were compared with Methicillin-susceptible Staphylococcus aureus (CA-MSSA) infections. In this study, 620 paediatric patients were included. The number of children in the CA-MRSA study group was 124, while the MSSA control group consisted of 496 children. Risk factors for CA-MRSA infections included young age (1-5years), female sex, Arab ethnicity and residence in East Jerusalem. The incidence of CA-MRSA increased over the past decade, with an average of 11.2%. An increase in MSSA resistance to clindamycin was noted while Trimethoprim-Sulphamethoxazole resistance remained low. The incidence of CA-MRSA in Jerusalem was rising, along with changes in resistance patterns of both MSSA and MRSA to various antibiotic agents. In order to optimise empirical treatment for suspected staphylococcal infection, continued monitoring of CA-MRSA prevalence and resistance rates is essential.

Genetic diversity of pvl- positive community-onset methicillin-resistant Staphylococcus aureus isolated at a university hospital in Japan

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is pathogenic to healthy individuals and a significant issue throughout the world. Panton-Valentine leukocidin gene (pvl)-positive sequence type (ST) 8-staphylococcal cassette chromosome (SCC) mec type IV (ST8-IV) as represented by the USA300 clone, is the most prevalent CA-MRSA in many countries. However, the prevalence of pvl-positive CA-MRSA was limited in Japan. Here, we report the incidence of pvl-positive community-onset MRSA (CO-MRSA) isolated from 10 patients seen between 2009 and 2014at a Japanese university hospital. All patients were Japanese and eight cases involved severe skin infections. Antimicrobial susceptibility patterns of the pvl-positive isolates were consistent with those of a typical CA-MRSA clone. Detailed molecular epidemiological analyses showed that three isolates were ST8-IV USA300 clones, whereas the other seven were ST30-IV (three isolates), ST30-I (one isolate), ST59-V (two isolates), and ST1-V (one isolate) clones. No clear difference of infection severity was found between the patients associated with the USA300 clone and those with the other clones. Our findings show that, not only the USA300 clone, but also diverse pvl-positive CO-MRSA clones exist in the community and cause severe skin infections in Japan.

THE FREQUENCY OF COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (CA-MRSA) AMONG SAMPLES IN INSTITUTE FOR PUBLIC HEALTH IN CANTON SARAJEVO.

Background:The increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections lacking risk factors for exposure to the health care system has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). These strains have been distinguished from health care-associated MRSA (HA-MRSA) strains by epidemiological, molecular and genetic means as well as by antibiotic susceptibility profile, tissue tropism and virulence traits.Objective:To assess prevalence and antibiotic susceptibility profile of CA-MRSA in Canton Sarajevo, Bosnia and Herzegovina.Results:Out of 1.905 positive Staphylococcus aureus isolates from various samples of outpatients collected during six months, 279 (14,64%) were MRSA isolates. Out of 279 MRSA samples, 133 (47,67%) were found in nasal swabs, from which 48 (36,09%) were in the age group <1 year and 39 (29,32 %) are in the age 1-5 year. Rate of the positive skin swabs was highest among the subject of age group <1 year (46 or 54,12 %) and 1-5 year (18 or 21,18 %). Predominantly antibiotic types among MRSA strains are resistant to penicillin and cefoxitin (36,90 %) and to penicillin, cefoxitin and erythromycin (61,35 %).Conclusion:Continued monitoring of epidemiology and emerging drug resistance data is critical for the effective management of these infections.

Molecular epidemiological study of community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA) - an examination of commercially distributed meat as a possible vehicle for CA-MRSA

Staphylococcus aureus has occupied an important position in public health as a cause of food poisoning and hospital-acquired MRSA (HA-MRSA) infections. The spread of community-acquired MRSA (CA-MRSA) infections has also recently become a concern. However, the sources of this infection remain unclear, and there are few reports of epidemiology information. In order to understand MRSA spread in the community, we investigated the distribution of MRSA strains in commercially distributed raw meat samples (n=305) and stool samples from outpatients with diarrhea (n=1,543) from the same meat distribution region in Oita Prefecture, Japan. 301 Staphylococcus aureus strains were isolated and 18 of them were MRSA (2 from chicken meat, 1 from duck meat, 1 from pork meat, and 14 from patients with diarrhea). All 18 MRSA strains were negative for Panton-Valentine leucocidin gene. In this study conducting a comparison of properties and a molecular epidemiological analysis of MRSA isolated from commercially distributed meat and diarrhea patient stools, the results suggest that commercially distributed meat could play a role in the prevalence of CA-MRSA in the community.

Prevalence and invasiveness of community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis.

Reports suggest that the prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased, and that CA-MRSA is more virulent than healthcare-associated (HA)-MRSA. The aim of this study is to gain a better understanding of the invasiveness and prevalence of CA-MRSA in patients; we systematically reviewed the literature by conducting a meta-analysis. We searched the MEDLINE and PUBMED databases from the year these databases were established to January 2013. The pooled CA-MRSA prevalence among 50,737 patients from 33 studies was 39.0% (range, 30.8-47.8%). The pooled CA-MRSA prevalence rates among pediatric and adult patients with MRSA infection were 50.2% (range, 37.5-62.8%) and 42.3% (range, 16.4-73.3%), respectively. The pooled CA-MRSA prevalence rates of MRSA-infected patients in Asia, Europe, and North America were 23.1% (range, 12.0-39.8%), 37.4% (range, 21.1-56.4%), and 47.4% (range, 35.8-59.4%), respectively. Using the random effects model, we determined that the pooled odds ratio of invasive infections in CA- and HA-MRSA was 0.30 (95% confidence interval: 0.08-1.10; P = 0.07, test for heterogeneity P < 0.00001). The prevalence of CA-MRSA in MRSA infection varied with area and population. No difference in the ability to cause invasive infections was found between CA- and HA-MRSA. This finding challenges the view that CA-MRSA is more virulent than HA-MRSA.

Inadequate Postgraduate Training of Skin and Soft Tissue Infections in an Era of Community-Associated Methicillin-Resistant Staphylococcus aureus

BackgroundSince 2002, the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) has been steadily increasing and CA-MRSA may now account for most community-based SSTIs. Although...

Molecular characterization of the first community-acquired methicillin-resistant Staphylococcus aureus strains from Central Iran

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has spread throughout the world with varying regional incidences and different staphylococcal cassette chromosome mec (SCCmec) elements in different genetic backgrounds. No information is available on CA-MRSA in Iran. A cross-sectional study was carried out among healthy students to investigate: (1) the prevalence of CA-MRSA in Central Iran, (2) the molecular epidemiology of such CA-MRSA strains, (3) the antimicrobial resistance patterns of the strains, and (4) the distribution of virulence genes in these CA-MRSA strains. A total of 700 nasal swabs were collected and subjected to S. aureus and MRSA-specific isolation procedures. Antimicrobial resistance patterns were determined using the disk diffusion method, and molecular typing was carried out by multi-locus sequence typing (MLST), SCCmec typing, and Staphylococcus protein A (spa) typing for all CA-MRSA isolates. PCR was used to detect various virulence genes. One hundred fifty-four S. aureus strains were isolated from the anterior nares of 700 healthy students. According to the US Centers for Disease Control and Prevention definitions for CA-MRSA, seven (4.5%) isolates were confirmed as CA-MRSA. CA-MRSA isolates belonged to SCCmec types IV (n = 6) and V (n = 1). The predominant spa-type among the CA-MRSA isolates was t790 (n = 3), with single t660, t084, and t325 isolates; one isolate was not typeable. The predominant sequence type was ST22, t790, SCCmec IV in three isolates, and the four other sequence types were ST25, ST859, ST14, and ST15. Iranian CA-MRSA strains are genetically diverse with an elevated prevalence of t790/ST22 SCCmec IV isolates. These findings support the need for more effective infection control measures to reduce nasal carriage and prevent dissemination of CA-MRSA in Iran.

Acute Bacterial Skin Infections: Developments Since the 2005 Infectious Diseases Society of America (IDSA) Guidelines

BackgroundPatients with acute bacterial skin and skin structure infections (ABSSSI) commonly present to Emergency Departments (EDs) where physicians encounter a wide spectrum of disease severity. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in the past decade, and CA-MRSA is now a predominant cause of purulent ABSSSI in the United States (US). ObjectivesThis article reviews significant developments since the most recent Infectious Diseases Society of America (IDSA) guidelines for the management of ABSSSI in the CA-MRSA era, focusing on recent studies and recommendations for managing CA-MRSA, newer antimicrobials with improved MRSA activity, new diagnostic technologies, and options for outpatient parenteral antimicrobial therapy (OPAT). DiscussionThe increasing prevalence of CA-MRSA has led the IDSA and other organizations to recommend empiric coverage of CA-MRSA for purulent ABSSSI. The availability of rapid MRSA detection assays from skin and soft tissue swabs could potentially facilitate earlier selection of targeted antimicrobial therapy. Several newer intravenous antibiotics with expanded MRSA coverage, including ceftaroline fosamil, daptomycin, linezolid, and telavancin, may be utilized for treatment of ABSSSI. OPAT may be an option for intravenous administration of antibiotics in selected patients and may prevent or shorten hospitalizations, decrease readmission rates, and reduce nosocomial infections and complications. ConclusionThe growing prevalence of CA-MRSA associated with ABSSSI in the US has a significant impact on clinical management decisions in the ED. Recent availability of new diagnostic testing and therapeutic options may help meet the demand for effective antistaphylococcal agents.

Prospective analysis methicillin-resistant staphylococcus aureus and its risk factors

Background:Since the early nineties, a new methicillin-resistant Staphylococcus aureus (MRSA) has existed in a form correlating with community health personnel. Community-acquired MRSA (CA-MRSA) could be differentiated from healthcare-associated MRSA (HA-MRSA) microbiologically, epidemiologically, and molecularly.Aims:To determine the prevalence, risk factors of MRSA infections in community and hospital.Settings:The incidence and risk factors for CA-MRSA and HA-MRSA among patients of medical, surgical, and pediatrics wards and ICU at a Kuwaiti teaching hospital between 1 March 2011 and 30 November 2011 were studied.Materials and Methods:Cultures for MRSA were taken from nasal (nostril), groin, axilla, wound, sputum, or throat, and the inguinal area in all enrolled patients upon admission. All preserved isolates were examined for their susceptibility to different types of antibiotics.Results and Conclusion:A total of 71 MRSA patients admitted to different hospital wards were examined. Among these patients, 52 (73.2%) were carriers of MRSA before they were admitted to the hospital. Nineteen patients (26.8%) were found to have acquired MRSA during their stay in the hospital. Twenty-nine patients (40.8%) were given mupirocin local skin antibiotic. Binomial and the t-test (paired) were used to compare the prevalence of CA-MRSA and HA-MRSA; significant correlation (P < 0.05) between the type of MRSA and different wards, sites, and lengths of hospital stay was found. The level of serum albumin that is routinely measured at hospital admission is a predictor to MRSA infection. This study suggests that S. aureus and MRSA should become a national priority for disease control to avoid outbreaks.

Study of Patients with Community-Acquired Abscesses

Abscess incision and drainage (I&D) operations form the bulk of surgical procedures in the emergency department (ED). Nevertheless, epidemiologic, clinical, and bacteriology data are lacking for patients with abscesses presenting at Sudanese hospitals. Information also is unavailable on the magnitude of the problem of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and its susceptibility to the most commonly used antibiotics. Our objectives were (1) to identify and document the epidemiologic and clinical variables of patients with superficial abscesses; (2) to isolate the causative organism(s) from the pus and determine their antibiotic sensitivity; (3) to determine the prevalence of CA-MRSA and its antibiotic susceptibility; and (4) to audit our practice of I&D of abscesses. A prospective observational study, involving a convenience sample of patients who presented with community-acquired skin and soft tissue (superficial) abscesses to a single unit at Khartoum North Teaching Hospital (KNTH) ED, was done for the years 2009-2010. A pro-forma was designed to record the personal, epidemiologic, and clinical data of each patient. All I&D operations were performed as day cases. Swabs of pus drained from the abscess were sent to the laboratory for culture. Isolates underwent sensitivity testing against the most commonly used antibiotics. A total of 248 patients were included. The majority (84%) were younger than 40 years of age. There were twice as many male as female patients (69% vs. 31%, respectively). The majority of patients did not have a known predisposing factor, but 13% had a history of an abscess. A history of trauma was found in 27% of the patients, whereas diabetes mellitus was found in only 6%. The most common site of the abscess was the upper limb (46%) followed by the lower limb (20%). Most (85%) of the abscesses were drained under local anesthesia. Sensitivity tests were performed on 151 pus isolates. No growth was obtained in 28 (18.5%) of the specimens. Of the 123 specimens yielding growth, S. aureus was the most common organism (90%), followed by Klebsiella spp. (6.5%). The proportion of CA-MRSA was 24%. Many of these S. aureus isolates were resistant to other antibiotics also. This study documents some epidemiologic and bacteriological data on one of the most common surgical problems. We found a substantial proportion of the infecting organisms to be CA-MRSA. This reflects the abuse of antibiotics in the community and stresses the importance of health education. Standardized surgical and anesthetic guidelines should be followed for I&D of abscesses to avoid recurrence. Further studies are needed urgently.

Commercially Distributed Meat as a Potential Vehicle for Community-Acquired Methicillin-Resistant Staphylococcus aureus

The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has been increasing; however, the sources of infection remain unclear. Therefore, we investigated the involvement of meat as a possible mediator of CA-MRSA infection. We examined the distribution of MRSA strains in commercially distributed raw meat samples (n = 197) and diarrheal stool samples of outpatients (n = 1,287) that were collected in Oita Prefecture, Japan, between 2003 and 2009 for routine legal inspections. Fourteen MRSA strains were isolated from three meat and 11 stool samples. Among these, seven isolates from three meat and four stool samples exhibited the same epidemiological marker profiles [coagulase type III, staphylococcal enterotoxin C, staphylococcal chromosomal cassette mec (SCCmec) type IV, ST8, spa type 606 (t1767), and toxic shock syndrome toxin-1 (TSST-1) producing type]. Furthermore, of the seven strains, three isolates from two meat samples and one stool sample collected in 2007 exhibited completely identical characteristics with respect to phage open reading frame (ORF) typing, pulsed-field gel electrophoresis, and drug susceptibility profiles. The results suggest that commercially distributed meat could play a role in the prevalence of CA-MRSA in the community.

Primary Care Management of Pediatric Community-Acquired Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections

Background The prevalence of pediatric community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) have been well documented, yet evidence supporting treatment standards for short- and long-term resolutions is equivocal. Objective To review the healthcare challenge of pediatric CA-MRSA SSTIs and describe current evidence concerning treatment of uncomplicated infections. Implications and recommendations for primary care practice are presented. Review of Literature Databases were searched using the keywords CA-MRSA, skin, soft tissue infections, antibiotics, incision and drainage, clindamycin, and trimethoprim-sulfamethoxazole to locate the highest level of evidence available. Further searches were conducted to investigate the epidemiology, history of antibiotic resistance, and past treatment of SSTIs including CA-MRSA. Results When treating a pediatric patient for an uncomplicated CA-MRSA SSTI, the primary care practitioner needs to consider patient history and comorbid conditions, location of the infection, size of lesion, community prevalence of CA-MRSA and its susceptibility, history of antibiotic use, family or close contact history of CA-MRSA, immunocompetence, and physical signs of the patient. Conclusion Treatment changes are paramount in the fight against CA-MRSA, and practitioners must follow the clinical practice guidelines and begin to utilize incision and drainage more frequently and antibiotics less frequently.

Improving the Management of Skin and Soft Tissue Infections in Primary Care: A Report From State Networks of Colorado Ambulatory Practices and Partners (SNOCAP-USA) and the Distributed Ambulatory Research in Therapeutics Network (DARTNet)

Purulent skin and soft tissue infections (SSTIs) requiring medical attention are often managed in primary care. The prevalence of SSTIs caused by community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasing rapidly, including in otherwise healthy individuals. The Centers for Disease Control and Prevention (CDC) issued guidelines to improve the management of SSTIs in primary care. In primary care settings, to assess the prevalence of CA-MRSA using an electronic chart audit and then evaluate SSTI management strategies consistent with CDC guidelines. A practical intervention that compared a historical cohort to an intervention cohort of patients seen for SSTI in 16 primary care practices in two health care systems. The intervention included a ready-made kit for I & D procedures, MRSA information for clinicians, a patient information handout, provider education, and patient follow-up. A total of 3112 SSTI cases (cellulitis or purulent) were observed during the preintervention period and 1406 cases during the intervention. For purulent infections in the intervention period (n = 148), univariate and multivariate analyses showed no significant improvement in the rate of I & D procedures or cultures obtained but showed increased use of antibiotics overall and agents that typically cover MRSA strains (OR, 2.183; 95% CI, 1.443 to 3.303 and 2.624; 95% CI, 1.500 to 4.604, respectively). For infections that were cellulitis with or without purulence (n = 1258), overall rates in the use of antibiotics and those that cover MRSA increased significantly, but secular trends could not be ruled out as an explanation for this increase. In SSTIs, this intervention resulted in increased use of antibiotics, including antibiotics that typically cover MRSA strains, but did not demonstrate increased rates of recommended drainage procedures. It is replicable and portable, and may improve antibiotic selection in other settings.

MRSA Central Skull Base Osteomyelitis and Occipital Condylar CSF Leak

Objective: Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important pathogen in paranasal sinus disease. However, CA-MRSA has been a rarely reported source of central skull base osteomyelitis or a subsequent occipital condylar cerebrospinal fluid leak in an otherwise immunocompetent patient. Method: Case report and current literature review. Results: We report on an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA-MRSA sphenoid sinusitis requiring endoscopic surgical repair. Conclusion: The increasing prevalence of CA-MRSA, in conjunction with its potential for intracranial complications, challenges the otolaryngologist to remain vigilant about detecting its possible manifestations. This case clearly demonstrates the expanding spectrum of severe infections caused by CA-MRSA, which requires prompt diagnosis and appropriate medical and/or surgical management.

The first report in Brazil of severe infection caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emergent pathogen in Brazil. However, there are no data on the prevalence of CA-MRSA. We report here the first well-characterized case of severe life-threatening CA-MRSA infection in a child living in Rio de Janeiro city. The patient had many complications including hematogenous osteomyelitis and involvement of multiple sites requiring drainage of soft-tissue abscess, and pleural and pericardial empyema. The MRSA isolates recovered were genotyped using PFGE, SCCmec typing and multilocus sequence typing. Disk diffusion tests were performed following Clinical and Laboratory Standards Institute recommendations. In addition, the presence of Panton-Valentine leukocidin (PVL) was assessed by PCR amplification, using specific primers for lukF-pv (encoding for the F subunit of the PVL). The bacterial isolates were related to the ST30-SCCmecIV lineage (Oceania Southwest Pacific clone), a PVL producer CA-MRSA previously detected in Porto Alegre, RS, Brazil. Also, the isolates analyzed were susceptible to all non-beta-lactam antibiotics tested. The present report demonstrates that disseminated CA-MRSA disease is also occurring in Rio de Janeiro. Thus, the empirical treatment of moderate or severe infections suspected of being associated with CA-MRSA needs to be reviewed in order to allow prompt initiation of an effective therapy that also covers these microorganisms.

Methicillin-Resistant Staphylococcus aureus Furunculitis in the Outpatient Burn Setting

Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more predominant in the community. We have seen increasing cases of furunculitis in our outpatient burn clinic, which appear to develop weeks after the initial burn injury and in patients with limited inpatient stays. We performed a 3-year retrospective review of all outpatient burn patients who developed furunculitis. Data analyzed included length of hospital stay, type of injury sustained, culture and sensitivity results, and treatment provided. A total of 28 patients were identified with MRSA furunculitis, which presented as painful, hard, indurated boils with minimal purulent drainage. Adults had less extensive burn injuries (mean of 12% TBSA adults vs 20% TBSA children) with shorter hospital stays (mean 8 days adults vs 22 days children). Fifty-seven percent of the patients had multiple furuncules, involving both burned and nonburned areas. Patients with furunculitis had a less resistant MRSA strain than those without furunculitis. Of the 22 patients who received systemic antibiotic coverage, 14 (58%) were successfully treated with 1 antibiotic regimen, whereas 8 (33%) required multiple antibiotics. In this study, furunculitis in the outpatient setting was believed to be consistent with community-acquired MRSA. Incision and drainage was not sufficient in patients with multiple furuncles, and systemic antibiotics were administered. Through increased awareness of the prevalence of community-acquired MRSA in the community, appropriate antibiotic treatment can be initiated, and the discomfort and transmission risk associated with this disease can be minimized.

Community-Acquired MRSA Infections in North Carolina Children: Prevalence, Antibiotic Sensitivities, and Risk Factors

The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and present a large burden to the health care system and to afflicted families. Our aims were to characterize the patterns of CA-MRSA resistance to common antibiotics and to identify significant risk factors for CA-MRSA infection in healthy children at a large urban hospital. Additional goals were to discover the prevalence of CA-MRSA in the institution and to observe any notable trends surrounding CA-MRSA infection in the facility. We retrospectively analyzed the medical records of patients under 18 years of age in the WakeMed Health and Hospitals system with cultures positive for Staphylococcus aureus over a period of seven and a half months in 2006. Cases were classified as community-acquired, and we then analyzed risk factors and examined trends surrounding CA-MRSA infection. A total of 229 cases of Staphylococcus aureus infection were identified over the study period, of which 142 were CA-MRSA, a prevalence of 75.9% (95% CI, 69.5-82.3). Our CA-MRSA isolates were 98.6% sensitive to trimethoprim-sulfamethoxasole, 94.4% sensitive to tetracycline, 90.8% sensitive to clindamycin, and 59.9% sensitive to levofloxacin. Risk factors for CA-MRSA infection included parental employment in a school or daycare, family history of boils or MRSA, and antibiotic use by children in the past six months. Our definition of CA-MRSA is based on retrospective data from patient and family verbal histories in the medical record. We did not perform molecular genotyping of MRSA samples to confirm community-associated strains. CA-MRSA is now the predominant strain of Staphylococcus aureus causing childhood infections in this central North Carolina hospital. Thus, standard antibiotic therapy with penicillins or first generation cephalosporins is no longer adequate for most pediatric skin and soft tissue infections in this population. Trimethoprim-sulfamethoxasole and clindamycin both appear as reasonable alternatives for empiric therapy.

Board-certified emergency physicians' treatment of skin and soft tissue infections in the community-acquired methicillin-resistant Staphylococcus aureus era

BackgroundEmergency physicians commonly treat skin and soft tissue infections. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has become the prominent etiologic agent in these infections. The CA-MRSA is resistant to many antibiotics traditionally used to treat skin and soft tissue infections. Study objectivesWe aim to identify how the increased prevalence of CA-MRSA has changed emergency medicine physician (EMP) prescribing and treatment practices for community-acquired skin and soft tissue infections. MethodsThe EMPs in the United States were surveyed between June and December of 2006. Two cases of skin and soft tissue infection were presented, and questions were asked about management. ResultsTwo hundred seventy-five surveys were returned. The EMPs used a variety of approaches in the antibiotic treatment of skin and soft tissue infections. Two hundred seven (75.3%) of 275 were board-certified EMPs and were included in the analysis. Commonly used agents for outpatient treatment include trimethoprim/sulfamethoxazole, clindamycin, cephalexin, rifampin, and tetracyclines. For patients requiring admission, 60% of providers would include vancomycin in their treatment regimen. ConclusionMany clinicians have changed their practice patterns to include antibiotics that usually display activity against CA-MRSA. However, cephalexin remains a popular agent used for these infections.