Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection.
Timothy S. Naimi,Kathleen H. LeDell,Kathryn Como-Sabetti,Stephanie M. Borchardt,David Boxrud,Jerome Etienne,Susan K. Johnson,François Vandenesch,Scott K. Fridkin,Carol O'Boyle,Richard Danila,Ruth Lynfield +11 more
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It is suggested that most community-associated MRSA strains did not originate in health care settings, and that their microbiological features may have contributed to their emergence in the community.Abstract:
Context Methicillin-resistant Staphylococcus aureus (MRSA) has traditionally been considered a health care–associated pathogen in patients with established risk factors. However, MRSA has emerged in patients without established risk factors (community-associated MRSA). Objective To characterize epidemiological and microbiological characteristics of community-associated MRSA cases compared with health care–associated MRSA cases. Design, Setting, and Patients Prospective cohort study of patients with MRSA infection identified at 12 Minnesota laboratory facilities from January 1 through December 31, 2000, comparing community-associated (median age, 23 years) with health care–associated (median age, 68 years) MRSA cases. Main Outcome Measures Clinical infections associated with either communityassociated or health care–associated MRSA, microbiological characteristics of the MRSA isolates including susceptibility testing, pulsed-field gel electrophoresis, and staphylococcal exotoxin gene testing. Results Of 1100 MRSA infections, 131 (12%) were community-associated and 937 (85%) were health care–associated; 32 (3%) could not be classified due to lack of information. Skin and soft tissue infections were more common among communityassociated cases (75%) than among health care–associated cases (37%) (odds ratio [OR], 4.25; 95% confidence interval [CI], 2.97-5.90). Although communityassociated MRSA isolates were more likely to be susceptible to 4 antimicrobial classes (adjusted OR, 2.44; 95% CI, 1.35-3.86), most community-associated infections were initially treated with antimicrobials to which the isolate was nonsusceptible. Communityassociated isolates were also more likely to belong to 1 of 2 pulsed-field gel electrophoresis clonal groups in both univariate and multivariate analysis. Communityassociated isolates typically possessed different exotoxin gene profiles (eg, Panton Valentine leukocidin genes) compared with health care–associated isolates. Conclusions Community-associated and health care–associated MRSA cases differ demographically and clinically, and their respective isolates are microbiologically distinct. This suggests that most community-associated MRSA strains did not originate in health care settings, and that their microbiological features may have contributed to their emergence in the community. Clinicians should be aware that therapy with -lactam antimicrobials can no longer be relied on as the sole empiric therapy for severely ill outpatients whose infections may be staphylococcal in origin.read more
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Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic odyssey.
TL;DR: Methicillin-resistant Staphylococcus aureus has undergone rapid evolutionary changes and epidemiologic expansion and has led to an important change in the choice of antibiotics in the management of community-acquired infections and has also led to the development of novel antimicrobials.
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A U.S. Population-Based Survey of Staphylococcus aureus Colonization
TL;DR: The U.S. population epidemiology of S. aureus colonization is described and genetic factors and toxin production genes in colonizing strains of both MSSA and MRSA and antibiotic resistance patterns for staphylococcal chromosomal cassette mec type II and SCCmec type II are compared.
Journal ArticleDOI
Natural History of Community-Acquired Methicillin-Resistant Staphylococcus aureus Colonization and Infection in Soldiers
TL;DR: CA-MRSA colonization with PVL-positive strains was associated with a significant risk of soft-tissue infection, suggesting that CA- MRSA may be more virulent than MSSA.
Journal ArticleDOI
High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections
Bradley W. Frazee,Jeremy Lynn,Edwin D. Charlebois,Larry Lambert,Derrick Lowery,Francoise Perdreau-Remington +5 more
TL;DR: In this urban ED population, MRSA is a major pathogen in skin and soft tissue infections and should be considered when empiric antibiotic therapy is selected for such infections.
Journal ArticleDOI
Linezolid versus Vancomycin in Treatment of Complicated Skin and Soft Tissue Infections
John A. Weigelt,Kamal M.F. Itani,Dennis L. Stevens,William Lau,Matthew Dryden,Charles Knirsch +5 more
TL;DR: The results of this study demonstrate that linezolid therapy is well tolerated, equivalent to vancomycin in treating CSSTIs, and superior to vanxellicillin-resistant Staphylococcus aureus in the treatment ofCSSTIs due to MRSA.
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