Soft Tissue Infections In Patients Research Articles

The unusual glycine-rich C terminus of the Acinetobacter baumannii RNA chaperone Hfq plays an important role in bacterial physiology

Acinetobacter baumannii is a Gram-negative nosocomial pathogen that causes soft tissue infections in patients who spend a long time in intensive care units. This recalcitrant bacterium is very well known for developing rapid drug resistance, which is a combined outcome of its natural competence and mobile genetic elements. Successful efforts to treat these infections would be aided by additional information on the physiology of A. baumannii Toward that end, we recently reported on a small RNA (sRNA), AbsR25, in this bacterium that regulates the genes of several efflux pumps. Because sRNAs often require the RNA chaperone Hfq for assistance in binding to their cognate mRNA targets, we identified and characterized this protein in A. baumannii The homolog in A. baumannii is a large protein with an extended C terminus unlike Hfqs in other Gram-negative pathogens. The extension has a compositional bias toward glycine and, to a lower extent, phenylalanine and glutamine, suggestive of an intrinsically disordered region. We studied the importance of this glycine-rich tail using truncated versions of Hfq in biophysical assays and complementation of an hfq deletion mutant, finding that the tail was necessary for high-affinity RNA binding. Further tests implicate Hfq in important cellular processes of A. baumannii like metabolism, drug resistance, stress tolerance, and virulence. Our findings underline the importance of the glycine-rich C terminus in RNA binding, ribo-regulation, and auto-regulation of Hfq, demonstrating this hitherto overlooked protein motif to be an indispensable part of the A. baumannii Hfq.

Antimicrobial therapy for methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recently, community-associated MRSA has emerged, manifesting as skin and soft tissue infections in patients without any prior healthcare contact. Vancomycin, a glycopeptide in clinical use for m...

Low yield of blood and wound cultures in patients with skin and soft-tissue infections

BackgroundCurrent guidelines recommend blood cultures in skin and soft-tissue infection (SSTI) patients only with signs of systemic toxicity and wound cultures for severe purulent infections. Our objectives were to determine: 1) blood and wound culture yields in patients admitted with SSTIs; 2) whether injection drug users (IDUs) and febrile patients had higher blood culture yields; and 3) whether blood and wound cultures grew organisms sensitive to typical SSTI empiric antibiotics. MethodsWe prospectively enrolled adult patients admitted from the ED with SSTIs at an urban hospital. We recorded patient characteristics, including IDU, comorbidities and temperatures, and followed admitted patients throughout their hospital course. ResultsOf 734 SSTI patients enrolled, 246 (33.5%) were admitted. Of 86 (35.0%) patients who had blood cultures, six had positive cultures (yield=7.0%; 95% confidence intervals [CIs] 3.2–14.4); 4 were methicillin sensitive Staphylococcus aureus (MSSA) and 2 were methicillin resistant (MRSA). Of 29 febrile patients, 1 had a positive culture (yield=3.5%; 95% CI 0.6–17.2). Of 101 admitted IDU patients, 46 (46%) received blood cultures, and 4 had positive cultures (yield=8.7%; 95% CI 3.4–20.3).Of 89 patients with purulent wounds, 44 (49.4%) patients had ED wound cultures. Thirteen had positive cultures (yield=29.6%; 95% CI 18.2–44.2%). Most were MRSA, MSSA, and group A Streptococcus species — all sensitive to Vancomycin. ConclusionsFebrile and IDU patients had low yields of blood cultures similar to yields in non-IDU and afebrile patients. All blood and wound culture species were adequately covered by currently recommended empiric antibiotic regimens.

Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005-2011.

More than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (EDs) yearly. Up to 50% of patients with SSTIs, suffer from recurrences, but associated factors remain poorly understood. We performed a retrospective study of patients with primary diagnosis of SSTI between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases and State Inpatient Databases. Using a multivariable logistic regression, we examined factors associated with a repeat SSTI ED visits up to 6 months after the initial SSTI. Among 197 371 SSTIs, 16·3% were associated with a recurrent ED visit. We found no trend in recurrent visits over time (χ 2 trend = 0·68, P = 0·4). Race/ethnicity, age, geographical location, household income, and comorbidities were all associated with recurrent visits. Recurrent ED visits were associated with drug/alcohol abuse or liver disease [odds ratio (OR) 1·4, 95% confidence interval (CI) 1·3-1·4], obesity (OR 1·3, 95% CI 1·2-1·4), and in infections that were drained (OR 1·1, 95% CI 1·1-1·1) and inversely associated with hospitalization after initial ED visit (OR 0·4, 95% CI 0·3-0·4). In conclusion, we found several patient-level factors associated with recurrent ED visits. Identification of these high-risk groups is critical for future ED-based interventions.

Molecular characterization of Staphylococcus aureus isolates causing skin and soft tissue infections in patients from Malakand, Pakistan.

Comparatively few studies have been published describing Staphylococcus aureus/MRSA epidemiology in Central Asia including Pakistan. Here, we report the genotyping of Staphylococcus aureus strains (that include both methicillin-susceptible and methicillin-resistant Staphylococcus aureus) from community- and hospital-acquired skin and soft-tissue infections in a tertiary care hospital in the Malakand district of the Khyber Pakhtunkhwa Province of Pakistan. Forty-five isolates of Staphylococcus aureus were characterized by microarray hybridization. Twenty isolates (44%) were MRSA, whereas 22 (49%) were PVL-positive. Fourteen isolates (31%) harboured both mecA and PVL genes. The dominant clones were CC121-MSSA (n = 15, 33%) and the PVL-positive "Bengal Bay Clone" (ST772-MRSA-V; n = 13, 29%). The PVL-positive CC8-MRSA-IV strain "USA300" was found once. The pandemic ST239-MRSA-III strain was absent, although it has previously been observed in Pakistan. These observations require a re-assessment of schemes for initial antibiotic therapy to cover MRSA and they emphasise the need for a rapid and non-molecular test for PVL.

The Prevalence of S. aureus Skin and Soft Tissue Infections in Patients with Pemphigus.

Pemphigus vulgaris are autoimmune blistering diseases that may result in significant morbidity and death. Immunosuppressive therapy of pemphigus vulgaris would predispose the patients to infections. The aim of this study was to assess the prevalence of S. aureus infection and PVL gene in patients with pemphigus admitted to dermatology clinic. Materials and Methods. This descriptive study was conducted on 196 pemphigus vulgaris patients (119 males, 77 females) admitted to dermatology clinic between 2014 and 2015. In this study, the diagnosis of pemphigus vulgaris was made by histology, immunofluorescence pattern of perilesional skin, and indirect immunofluorescence testing of serum. Data were collected through a questionnaire. Results. 59.1% of pemphigus vulgaris patients had S. aureus infection. 49 out of 116 were methicillin-resistant. PVL gene was detected in 25 out of 116 S. aureus positive patients. Conclusion. This is the first report of S. aureus infection in pemphigus patients in Iran. More than forty percent of isolates were methicillin-resistant S. aureus. PVL gene carried by methicillin-resistant S. aureus was high in this study.

Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China

We evaluated the epidemiological and molecular features of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-sensitive S. aureus (MSSA) from children and adult patients with skin and soft-tissue infections (SSTIs) in China. Prospective community-acquired S. aureus SSTI surveillance was conducted in 23 hospitals over a 24-month period. Susceptibility to 16 antimicrobials was evaluated using the agar dilution method. StatApriori was used to determine statistically significant association trends. The genotypic characteristics of CA-MRSA isolates were tested by staphylococcal cassette chromosome mec (SCCmec) typing, staphylococcal protein A (spa) typing, and multilocus sequence typing. The presence of Panton–Valentine leukocidin (pvl) genes was determined. Overall, 71.6% (1946/2716) of cases were community-associated S. aureus. CA-MRSA accounted for 2.6% (51). Out of 1895 methicillin-sensitive S. aureus strains, 97.3% were resistant to erythromycin, 96.6% to penicillin and 89.1% to clindamycin. No S. aureus strains were resistant to vancomycin. Thirteen sequence types (STs) and 17 spa types were detected among the CA-MRSA strains. The most prevalent sequence type was ST121 (19/51, 37.3%), followed by ST59 (13/51, 25.5%). In addition, t437 was predominant, accounting for 43.1% (22/51). Only five (9.8%) of the CA-MRSA strains harbored pvl genes. There were no significant differences in antibiotic sensitivity profiles between ST121 and non-ST121 MRSA isolates. However, ST121 strains tended to be more resistant to cefazolin, whereas non-ST121 strains were more resistant to chloramphenicol. In conclusion, CA-MRSA infections are rare among Chinese SSTI patients. MRSA strains in China have diverse genetic backgrounds, with ST121 being the predominant clone. Fusidic acid and mupirocin remain effective for topical treatment.

Antibiotics for skin and soft tissues infections in type 2 diabetes mellitus.

Type 2 diabetes mellitus is a chronic pathology characterized by high prevalence, high morbidity and mortality. According to the data of the Ministry of Health of Volgograd region the number of patients with type 2 diabetes was 68,227 people on 01.01.2014. Medical and social significance of type 2 diabetes mellitus is determined by its complications. Skin and soft tissue infections (SSTIs) in patients with type 2 diabetes are among the main factors of hospitalization and mortality [1]. Diabetic foot syndrome is found in 30-80% of patients [2]. Pharmacoepidemiological analysis of the structure of skin and soft tissues infections in patients with type 2 diabetes, taking into account data on pathogens, parameters of their sensitivity, analysis of prescribed medicines and evaluation of their compliance with current clinical guidelines and standards. A retrospective descriptive cross-sectional pharmacoepidemiological study using randomization by random numbers. The sample consisted of 253 medical records of patients with SSTIs and type 2 diabetes. These were patients admitted to the surgical departments of hospitals of the city of Volgograd for the period from January 2011 to December 2014. Gender structure was the following: 51.4% - women, 48.6% - men. The average age of patients was 64.5 years. The average number of hospital days was 19,5 ± 14,9. Diabetic foot syndrome was found in 81.3% of cases (n-204). The most common forms of diabetic foot syndrome were the following: gangrene of the lower extremities - 28% (n-58), ulcers of the skin - 26% (n-53), mixed forms of SSTIs - 18% (n-37 ). Surgical manipulations were performed in 39.1% of cases (n-99), including amputations in 65.7% (n-65) of cases. The blood glucose level on admission was studied in 97.6% (n-247), at discharge - in 89% (n-225). Urine analysis on admission was performed in 66.4% of patients (n-168), at discharge - in 51% of patients (n-129). The glycemic profile was studied in 81.4% of patients (n-206). Bacteriological sowing was carried out in 19% (n-48) of cases: blood - 4,2% (n-2), urine - 6,2% (n-3) (the growth of microorganisms was not detected in 100%); bacteriological sowing from the wound - in 89.6% (n-43), the growth of microorganisms were identified in 95.7% (n-44). Most common pathogens were: St. aureus - 28%, E. coli - 19%, St. epidermidis - 14%. Antibacterial medications were prescribed in 86% (n-216). These were: cephalosporin of the III generation - ceftriaxone (49.4%), other synthetic antibacterials - metronidazole (21%), fluoroquinolone - ciprofloxacin (7.5%). The highest levels of bacterial resistance of SSTIs pathogens were found to beta-lactam antibiotics (amoxicillin/clavulanic acid, ceftriaxone, and ampicillin), rifampin, and gentamicin. The highest levels of sensitivity of SSTIs pathogens were observed to levofloxacin, to vancomycin and meropenem. There is a vicious circle in patients with type 2 diabetes: the infectious process leads to decompensation of carbohydrate metabolism parameters; in turn, hyperglycemia leads to increase of severity of SSTIs. Normalization of glucose levels promotes prompt relief of symptoms of infection and bacterial eradication, rational treatment of infection contributes to rapid correction of glucose level. Therefore, an essential element of comprehensive treatment of this group of patients should be rational antibiotic therapy; the choice of medication should be based on the severity of the disease and potential etiologic agents [3]. The analysis of the degree of conformity of the pharmacotherapy to existing standards is a way to optimize the treatment of the given group of patients [4].

Clindamycin

Clindamycin

Molecular Characterization of Community-Associated Methicillin-Resistant Staphylococcus aureus Isolated from Skin and Pus Samples of Outpatients in Japan.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now endemic in the United States. In Japan, CA-MRSA infections and CA-MRSA surveillance have been scarcely reported. In this study, we conducted a nationwide survey of CA-MRSA in Japan. We collected MRSA strains isolated from outpatients with skin and soft-tissue infection (SSTI) at 107 medical facilities from 24 prefectures in 2010 and 2012. Among 10,385 clinical samples from SSTI patients, 3,581 S. aureus isolates (35%) were obtained and 673 of the S. aureus strains (19%) were identified as MRSA. Among 625 MRSA strains tested in this study, 266 strains (43%) and 114 strains (18%) were classified as SCCmec types IV and V, respectively. Detection of virulence genes was as follows: Panton-Valentine leukocidin (PVL) gene (57 strains, 9%), exfoliative toxin (ET) gene (179 strains, 29%), toxic shock syndrome toxin-1 (TSST-1) gene (195 strains, 31%), or none. PVL-positive strains were classified into eight sequence types (STs) (i.e., ST1, ST5, ST8, ST22, ST30, ST452, ST59, and ST154) and six clonal complexes (i.e., CC1, CC5, CC8, CC22, CC30, and CC59). Only 10 PVL-positive strains (2%) were pulsed-field type USA300 clone. There were a wide variety of CA-MRSA clones in Japan, which were different from the situation in the United States.

284Risk Factors for Methicillin Resistant Staphylococcus aureus Skin and Soft Tissue Infections in Patients Found to be Colonized When Admitted to an Acute Care Hospital

284Risk Factors for Methicillin Resistant Staphylococcus aureus Skin and Soft Tissue Infections in Patients Found to be Colonized When Admitted to an Acute Care Hospital

Antibiotics for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: the challenge of outpatient therapy

PurposeMethicillin-resistant Staphylococcus aureus (MRSA) infections are becoming increasingly prevalent in both community and hospital settings. Certain strains are notorious for causing skin and soft tissue infections in patients with no established risk factors. In this article, we report our findings on the dynamic antibiotic resistance pattern of MRSA and outpatient prescription trend for skin and soft tissue infections within our community. MethodsWe conducted a retrospective medical record review of 1876 patients evaluated in the emergency department of an urban community hospital from 2003 to 2012. Data regarding culture isolates and associated antimicrobial resistance, antibiotic treatment, site of specimen collection, age, race, and sex were collected and analyzed. ResultsAnalysis of 1879 culture specimens yielded 2193 isolates. In some cases, a single specimen yielded polymicrobial growth. Staphylococcus aureus represented 996 isolates (45.4%); 463 were methicillin-susceptible (21.1%) and 533 (24.3%) were methicillin-resistant. Most patients were prescribed a single- or poly-drug regimen of trimethoprim/sulfamethoxazole, cephalexin, and clindamycin. Antimicrobial resistance analysis indicated that MRSA became increasingly resistant to the aforementioned antibiotics over time: 10% and 6% in 2012 vs 3.5% and 3.4% in 2007 for clindamycin and trimethoprim/sulfamethoxazole, respectively. ConclusionMethicillin-resistant Staphylococcus aureus is a particularly virulent, rapidly adaptive pathogen that is becoming increasingly difficult to combat with existing antibiotics. Care must be taken to ensure appropriate treatment and follow-up of patients with known MRSA infections.

Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs. Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grew S. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes. Of the 1,353 S. aureus-positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptible S. aureus. We observed significant variation in both the prevalence of MRSA (11-100%) and the proportion of community-associated strains of MRSA (0-100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada. MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.

The Efficacy and Safety of Linezolid and Glycopeptides in the Treatment of Staphylococcus aureus Infections

To assess the effectiveness and safety of linezolid in comparison with glycopeptides (vancomycin and teicoplanin) for the treatment of Staphylococcus aureus infections, we conducted a meta-analysis of relevant randomized controlled trials. A thorough search of Pubmed and other databases was performed. Thirteen trials on 3863 clinically assessed patients were included. Linezolid was slightly more effective than glycopeptides in the intent-to-treat population (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01–1.10), was more effective in clinically assessed patients (OR 95% CI: 1.38, 1.17–1.64) and in all microbiologically assessed patients (OR 95% CI: 1.38, 1.15–1.65). Linezolid was associated with better treatment in skin and soft-tissue infections (SSTIs) patients (OR 95% CI: 1.61, 1.22–2.12), but not in bacteraemia (OR 95% CI: 1.24, 0.78–1.97) or pneumonia (OR 95% CI: 1.25, 0.97–1.60) patients. No difference of mortality between linezolid and glycopeptides was seen in the pooled trials (OR 95% CI: 0.98, 0.83–1.15). While linezolid was associated with more haematological (OR 95% CI: 2.23, 1.07–4.65) and gastrointestinal events (OR 95% CI: 2.34, 1.53–3.59), a significantly fewer events of skin adverse effects (OR 95% CI: 0.27, 0.16–0.46) and nephrotoxicity (OR 95% CI: 0.45, 0.28–0.72) were recorded in linezolid. Based on the analysis of the pooled data of randomized control trials, linezolid should be a better choice for treatment of patients with S. aureus infections, especially in SSTIs patients than glycopeptides. However, when physicians choose to use linezolid, risk of haematological and gastrointestinal events should be taken into account according to the characteristics of the specific patient populations.

Characterization of methicillin-resistant Staphylococcus aureus from skin and soft tissue infections in patients in Nairobi, Kenya

Skin and soft tissue infections (SSTIs) are among the most common infectious diseases and a frequent cause of hospital visits. In this study we sought to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and antibiotic susceptibility patterns in SSTIs in patients attending hospitals in Kenya. Eighty-two S. aureus isolates recovered from SSTIs from both inpatients and outpatients were screened for antibiotic susceptibility, possession of staphylococcal cassette chromosome mec (SCCmec) gene type, and the Panton-Valentine leukocidin (PVL) toxin gene. The prevalence of MRSA was investigated in relation to the type of patient and infection type, as well as the type of health care facility. Of 60 boil cultures, 39 (65%) grew S. aureus, of out of which 34 (87.2%) were MRSA. Of the 60 abscess cultures, 14 (23.3%) grew S. aureus, of which 10 (71.4%) were MRSA. Of 34 cellulitis cultures, 18 (52.9%) grew S. aureus, of which 16 (88.8%) were MRSA. Of 25 ulcer cultures, 11 (44%) grew S. aureus, of which nine (81.8%) were MRSA. Sixty-nine of 82 S. aureus (84.1%) were MRSA, with 52 (75.4%) possessing SCCmec II type and 14 (20.3%) being positive for the PVL gene. Based on hospitals, it was noted that most MRSA were isolated at publicly funded health care facilities serving an economically disadvantaged segment of Nairobi's population, such as those living in urban informal settlements. All 82 S. aureus were susceptible to vancomycin and resistant in high numbers to macrolides, aminoglycosides, and quinolones. Bacterial isolates were mostly susceptible to vancomycin, ciprofloxacin and co-trimoxazole, and none was resistant to vancomycin. However, most organisms showed decreased susceptibility to erythromycin and clindamycin. These findings suggest that SCCmec II MRSA and a PVL strain of MRSA are significant pathogens in patients with SSTIs presenting to hospitals in Kenya, and that MRSA cases are prevalent at publicly funded health care facilities.

Forehead Abscess Caused by Klebsiella oxytoca With Undiagnosed Type 2 Diabetes

Klebsiella is an opportunistic pathogen that is known to cause septicemia, pneumonia, urinary tract infections, hepatobiliary tract infections, and soft tissue infections in patients who have severe underlying diseases or are under immunosuppression. Most Klebsiella species found are Klebsiella pneumoniae, and Klebsiella oxytoca is rarely cultured in humans. We report a case of a 48-year-old man presenting with a soft fluctuating mass on his forehead. The lesion was an abscess, and percutaneous drainage yielded pus from which K. oxytoca was isolated. Parenteral levofloxacin was administrated leading to resolution of infection signs. Because of the rarity of the pathogen, evaluation for underlying illnesses was done, and the patient was diagnosed with type 2 diabetes mellitus. This is the first report of a patient with previously undiagnosed diabetes who was found with an extraorbital abscess caused by K. oxytoca, which we present with a review of diagnosis, pathogenesis, and treatment.

Skin and soft tissue infections in patients with solid tumours.

Background. Skin and soft tissue infections (SSTIs) in cancer patients represent a diagnostic challenge, as etiologic diagnosis is often missing, and clinical assessment of severity is difficult. Few studies have described (SSTIs) in patients with solid tumours (STs). Patients and Methods. Records of patients with ST and SSTI, cared for at the University Hospital of Heraklion, from 2002 to 2006 were retrospectively studied. Results. A total of 81 episodes of SSTIs, occurring in 71 patients with ST, have been evaluated. Their median age was 65 years (34–82). The most common underlying malignancy was breast cancer in 17 patients (24%). Most episodes (89%) occurred in nonneutropenics. Cellulitis/erysipelas was the most common clinical presentation (56; 69%). Bacterial cultures were possible in 29 (36%) patients. All patients received antimicrobial therapy, while in 17 episodes (21%) an incision and drainage was required. Treatment failure occurred in 20 episodes (25%). Five patients (7%) died due to sepsis. None was neutropenic. Severe sepsis on admission (P = 0.002) and prior blood transfusion (P = 0.043) were independent predictors of treatment failure. Conclusion. SSTIs can be life threatening among patients with ST. Early diagnosis and appropriate treatment are of the utmost importance, since sepsis was proven a significant factor of unfavourable outcome.

Prevalence and Predictors of Nasal and Extranasal Staphylococcal Colonization in Patients Presenting to the Emergency Department

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of skin and soft tissue infections in patients presenting to the emergency department (ED). The prevalence of asymptomatic MRSA colonization in ED patients is less well described, particularly in the absence of a skin and soft tissue infection-related complaint. The goals of this study are to assess the prevalence of nasal and extranasal staphylococcal colonization in ED patients, evaluate risk factors, and molecularly characterize the strains. We performed active surveillance for methicillin-susceptible S aureus (MSSA) and MRSA colonization in 400 subjects presenting to an urban ED. Risk factor assessment was performed and culture testing was conducted on anterior nares, oropharynx, palms, groin, perirectal area, wounds, and catheter insertion sites. Multiplex polymerase chain reaction was used to identify the USA300/400 clonal types. The prevalence of colonization with MSSA was 39% (95% confidence interval 34.2% to 44.0%), and prevalence of colonization with MRSA was 5% (95% confidence interval 3.1% to 7.6%). Among MRSA-colonized subjects, an extranasal site tested positive in 80% of subjects, and 45% had exclusive extranasal colonization. USA300 was identified in 55% of MRSA-colonized subjects. The main risk factors for MRSA colonization included HIV infection, diabetes, and participation in contact sports. The overall prevalence of MRSA colonization in this ED population was lower than that reported in other high-risk ambulatory care settings. However, extranasal colonization was present in more than half of MRSA-colonized subjects, and USA300 was the predominant clonal type.

Antibodies to Staphylococcus aureus Bone Sialoprotein-Binding Protein Indicate Infectious Osteomyelitis

Discrimination of soft tissue infection from osteomyelitis in diabetic foot infections is a common clinical problem. Staphylococcus aureus isolates from patients with osteomyelitis express bone sialoprotein-binding protein (Bbp) that binds the bone matrix protein bone sialoprotein. The serological assay with Bbp discriminated cases of osteomyelitis from soft tissue infections in patients with diabetic foot ulcers.

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant <i>Staphylococcus aureus</i>