Why is community-associated MRSA spreading across the world and how will it change clinical practice?

doi:10.1016/S0924-8579(09)70544-8

International Journal of Antimicrobial Agents

Volume 34, Supplement 1, July 2009, Pages S15-S19

https://doi.org/10.1016/S0924-8579(09)70544-8 Get rights and content

Abstract

Meticillin-resistant Staphylococcus aureus (MRSA) emerged in 1960 and over the following 40 years was a problem confined largely to the healthcare setting. In the late 1990s the first US reports of so-called community-associated MRSA (CA-MRSA) infections appeared. CA-MRSA infections were defined as MRSA infections occurring in patients who had no identifiable predisposing risk factors, such as healthy children and young adults. CA-MRSA is associated with a novel genetic profile and phenotype; it is remarkably fit and capable of spreading within communities, it is virulent and is often susceptible to multiple narrow-spectrum antimicrobials other than β-lactams. CA-MRSA infections involve predominantly skin and soft tissue; however, necrotizing pneumonia and necrotizing fasciitis have been described. At present, several reports suggest that CA-MRSA may be replacing the hospital-acquired MRSA strains (HA-MRSA), with potentially catastrophic consequences. Given the rapid spread and the high virulence of CA-MRSA, global strategies are needed. Prompt, appropriate treatment, guided by the site and type of infection and risk factors for HA-MRSA or CA-MRSA, increases the chances of a successful outcome and is urgently needed.

References (46)

TR Wallin et al.
Community-associated methicillin-resistant Staphylococcus aureus
Emerg Med Clin North Am
(2008)
M Barber et al.
Infection by penicillin-resistant staphylococci
Lancet
(1948)
JC Gould et al.
Staphylococcal infection in general practice
Lancet
(1957)
GJ Moet et al.
Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY antimicrobial surveillance program (1998–2004)
Diagn Microbiol Infect Dis
(2007)
Y Gillet et al.
Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients
Lancet
(2002)
P Collignon et al.
Community-acquired methicillin-resistant Staphylococcus aureus in Australia. Australian Group on Antimicrobial Resistance
Lancet
(1998)
M Patel et al.
Emergence of USA-300 MRSA in a tertiary medical centre: implications for epidemiological studies
J Hosp Infect
(2008)
T Baba et al.
Genome and virulence determinants of high virulence community-acquired MRSA
Lancet
(2002)
KM Itani et al.
Linezolid reduces length of stay and duration of intravenous treatment compared with vancomycin for complicated skin and soft tissue infections due to suspected or proven methicillin-resistant Staphylococcus aureus (MRSA)
Int J Antimicrob Agents
(2005)
RL Thompson et al.
Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus
Ann Intern Med
(1982)

JM Boyce

Methicillin-resistant Staphylococcus aureus: detection, epidemiology, and control measures

Infect Dis Clin North Am

(1989)

BC Herold et al.

Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk

JAMA

(1998)

From the Centers for Disease Control and Prevention, four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus – Minnesota and North Dakota, 1997–1999

JAMA

(1999)

WM Kirby

Extraction of a highly potential penicillin inactivator from penicillin resistant staphylococci

Science

(1944)

L Weinstein

The penicillins

O Jessen et al.

Changing staphylococci and staphylococcal infections: A ten-years study of bacteria and cases of bacteraemia

N Engl J Med

(1969)

S Ross et al.

Staphylococcal susceptibility to penicillin G: the changing pattern among community isolates

JAMA

(1974)

GB Hughes et al.

Staphylococci in community-acquired infections: Increased resistance to penicillin

Ann Surg

(1976)

DL Hahn et al.

Penicillin G susceptibility of ‘rural’ Staphylococcus aureus

J Fam Pract

(1980)

HF Chambers

The changing epidemiology of Staphylococcus aureus?

Emerg Infect Dis

(2001)

GJ Moran et al.

Methicillin-resistant Staphylococcus aureus in community-acquired skin infections

Emerg Infect Dis

(2005)

European Antimicrobial Resistance Surveillance System management team, members of the advisory board, and national...

GJ Moran et al.

Methicillin-resistant S. aureus infections among patients in the emergency department

N Engl J Med

(2006)

Cited by (87)

Republication of: Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis
2023, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
To verify the prevalence of Potentially pathogenic bacteria (PPB) and their antimicrobial resistance profile in tracheal aspirates of children with tracheostomy and compare it to clinical data.
A cross-sectional study was conducted in patients aged 0–18 years who all underwent tracheostomy cannula change (TCC) performed by the Otolaryngology Unit at Hospital de Clínicas de Porto Alegre, Brazil, between October, 2017 and December, 2018. Patients were submitted, at the time of TCC, to a tracheal aspirate through the tracheostomy and secretion was sent to microbiological analysis and antimicrobial susceptibility testing. Clinical data were evaluated through available patients’ electronic medical records.
Forty-four patients had their tracheostomy aspirate cultured and all but one presented PPB growth (97.7%). Median age was 3 years-old. Pseudomonas aeruginosa was the most prevalent bacteria (56.9%) and it was resistant to gentamycin, amikacin and cefepime in 36%, 28% and 12% of the culture tests, respectively. P. aeruginosa resistance to gentamycin and to cefepime suggested an association with the number of antibiotic classes used in the 12 months before enrollment (both p = 0.04) and with 2 or more hospital admissions in the same period (p = 0.03 and p = 0.02, respectively). Staphylococcus aureus was isolated in 9.1% and there was no MRSA.
It was found a 97.7% prevalence of PPB in the cultured aspirates; the most prevalent bacterium was P. aeruginosa and there was no MRSA identification. Data suggest an association between P. aeruginosa antimicrobial resistance with previous use of antibiotic therapy.
REDS study: Retrospective effectiveness study of dalbavancin and other standard of care of the same IV antibiotic class in patients with ABSSSI
2023, International Journal of Antimicrobial Agents
Acute bacterial skin and skin-structure infections (ABSSSIs) are a common source of morbidity in both the community and hospital settings. The current standard of care (SoC) requires multiple-dose intravenous (IV) regimens, which are associated with high hospitalisation rates, concomitant event risks and costs. Dalbavancin is a lipoglycopeptide, long-acting antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin allows treatment of ABSSSIs with a single-shot IV administration or once weekly for 2 weeks, enabling clinicians to treat patients in an outpatient setting or to shorten the length of hospital stay.
This multicentre, observational, retrospective study compared hospitalised patients who received dalbavancin and patients treated with the three most used IV antibiotics of the same or similar class: vancomycin, teicoplanin and daptomycin. The primary outcome was the time to discharge after starting the study antibiotics.
The primary endpoint, time to discharge from the study therapy start, was measured for both groups: the median number of days was 6.5 in the dalbavancin group vs. 11.0 days in the SoC group. Moreover, in subpopulations of patients receiving one or more concomitant antibiotics active for Gram-positives, MRSA and patients with the most prevalent comorbidity (i.e., diabetes), the advantage of dalbavancin in terms of length of stay was confirmed, with a halved time to discharge or more. Safety data on dalbavancin were consistent with data collected in clinical trials. No serious adverse drug reactions related to dalbavancin were reported and most of them were classified as skin and subcutaneous tissue disorders. One serious ADR was reported for daptomycin.
Although the analysis was only descriptive, it can be concluded that dalbavancin may enable a remarkable reduction in length of hospital stay, also confirming the clinical effectiveness and good safety profile demonstrated in clinical trials in a real-world setting.
Tracheostomized children tracheal colonization and antibiotic resistance profile – A STROBE analysis
2023, European Annals of Otorhinolaryngology, Head and Neck Diseases
To verify the prevalence of Potentially pathogenic bacteria (PPB) and their antimicrobial resistance profile in tracheal aspirates of children with tracheostomy and compare it to clinical data.
A cross-sectional study was conducted in patients aged 0–18 years who all underwent tracheostomy cannula change (TCC) performed by the Otolaryngology Unit at Hospital de Clínicas de Porto Alegre, Brazil, between October, 2017 and December, 2018. Patients were submitted, at the time of TCC, to a tracheal aspirate through the tracheostomy and secretion was sent to microbiological analysis and antimicrobial susceptibility testing. Clinical data were evaluated through available patients’ electronic medical records.
Forty-four patients had their tracheostomy aspirate cultured and all but one presented PPB growth (97.7%). Median age was 3 years-old. Pseudomonas aeruginosa was the most prevalent bacteria (56.9%) and it was resistant to gentamycin, amikacin and cefepime in 36%, 28% and 12% of the culture tests, respectively. P. aeruginosa resistance to gentamycin and to cefepime suggested an association with the number of antibiotic classes used in the 12 months before enrollment (both p = 0.04) and with 2 or more hospital admissions in the same period (p = 0.03 and p = 0.02, respectively). Staphylococcus aureus was isolated in 9.1% and there was no MRSA.
It was found a 97.7% prevalence of PPB in the cultured aspirates; the most prevalent bacterium was P. aeruginosa and there was no MRSA identification. Data suggest an association between P. aeruginosa antimicrobial resistance with previous use of antibiotic therapy.
Synthesis of ruthenium polypyridine complexes with benzyloxyl groups and their antibacterial activities against Staphylococcus aureus
2022, Journal of Inorganic Biochemistry
Four new ruthenium polypyridyl complexes, [Ru(bpy)₂(BPIP)](PF₆)₂ (Ru(II)-1), [Ru(dtb)₂(BPIP)](PF₆)₂ (Ru(II)-2), [Ru(dmb)₂(BPIP)](PF₆)₂ (Ru(II)-3) and [Ru(dmob)₂(BPIP)](PF₆)₂ (Ru(II)-4) (bpy = 2,2′-bipyridine, dtb = 4,4′-di-tert-butyl-2,2′-bipyridine, dmb = 4,4′-dimethyl-2,2′-bipyridine, dmob = 4,4′-dimethoxy-2,2′-bipyridine and BPIP = 2-(3,5-bis(benzyloxyl)phenyl)-1H-imidazo[4,5-f][1,10]phenanthroline) had been synthesized and characterized. Their antimicrobial activities were investigated against Staphylococcus aureus (S. aureus) and four complexes showed obvious antibacterial effect, especially the minimum inhibition concentration (MIC) value of Ru(II)-3 was only 4 μg/mL. In addition, Ru(II)-3 was able to kill bacteria quickly and inhibit the formation of biofilm. Meanwhile, the cooperative effect between Ru(II)-3 and general antibiotics were tested and the results showed that Ru(II)-3 could enhance the susceptibility of S. aureus to different types of antibiotics. Most importantly, Ru(II)-3 hardly showed cytotoxicity to mammalian erythrocytes both in homelysis experiment and G. mellonella model. After being injected with high doses of the Ru(II)-3in vivo, the G. mellonella worms still exhibited high survival rates. Finally, a mouse skin infection model and G. mellonella infection model was built to determine the antibacterial activity of Ru(II)-3in vivo. The antibacterial mechanism of Ru(II)-3 was probably related to the membrane-disruption. Taken together, ruthenium polypyridine complexes with benzyloxyl groups had the potential to develop an attractive and untraditional antibacterial agent with new mode of action.
Antimicrobial stewardship in patients with acute bacterial skin and skin-structure infections: An international Delphi consensus
2020, Journal of Global Antimicrobial Resistance
The aim of this survey was to identify a set of actions aimed to improve the diagnosis and management of acute bacterial skin and skin-structure infections (ABSSSIs) and the implementation of some principles of antimicrobial stewardship (AMS) in this setting.
A list of 76 statements for which there was a lack of clarity were generated by an expert panel and were validated by a group of experts. The questionnaire was administered to 112 experts in infectious diseases or microbiology. Participants were asked to vote on a list of statements. An agreement threshold of 66% was required to reach consensus.
Overall, 57 responders participated in the survey. Positive consensus was reached on the fact that ABSSSIs represent a significant cause of infection in the emergency department, are frequently associated with increased hospital stay and are mainly caused by Staphylococcus aureus. The panellists strongly supported collection of samples from purulent infections by needle aspiration as well as collection of blood cultures in the presence of signs/symptoms of systemic infection. The importance of source control and prompt adequate microbiological documentation, the objective to reduce the length of hospital stay, the choice of a narrow-spectrum antibiotic and the role of new therapeutic options (e.g. long-acting drugs) in improving compliance also reached a positive consensus.
This Delphi survey provides useful indicators for the implementation of AMS principles in the clinical management of ABSSSI and offers interesting elements of discussion about the barriers existing in Europe for optimal implementation of AMS programmes.
Antibiotic Management and Antibiotic Resistance in Hand Infections
2020, Hand Clinics

View all citing articles on Scopus

View full text

Why is community-associated MRSA spreading across the world and how will it change clinical practice?

Abstract

Emerg Med Clin North Am

Lancet

Lancet

Diagn Microbiol Infect Dis

Lancet

Lancet

J Hosp Infect

Lancet

Int J Antimicrob Agents

Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus

Ann Intern Med

Methicillin-resistant Staphylococcus aureus: detection, epidemiology, and control measures

Infect Dis Clin North Am

Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk

JAMA

From the Centers for Disease Control and Prevention, four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus – Minnesota and North Dakota, 1997–1999

JAMA

Extraction of a highly potential penicillin inactivator from penicillin resistant staphylococci

Science

The penicillins

Changing staphylococci and staphylococcal infections: A ten-years study of bacteria and cases of bacteraemia

N Engl J Med

Staphylococcal susceptibility to penicillin G: the changing pattern among community isolates

JAMA

Staphylococci in community-acquired infections: Increased resistance to penicillin

Ann Surg

Penicillin G susceptibility of ‘rural’ Staphylococcus aureus

J Fam Pract

The changing epidemiology of Staphylococcus aureus?

Emerg Infect Dis

Methicillin-resistant Staphylococcus aureus in community-acquired skin infections

Emerg Infect Dis

Methicillin-resistant S. aureus infections among patients in the emergency department

N Engl J Med