Cutaneous Community-acquired Methicillin-resistant Staphylococcus aureus Infection in Participants of Athletic Activities

Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and prevention

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection.

Cutaneous community-associated methicillin-resistant staphylococcus aureus among all skin and soft-tissue infections in two geographically distant pediatric emergency departments

OBJECTIVES

To describe the culture results of cutaneous infections affecting otherwise healthy children presenting to two pediatric emergency departments (EDs) in the southeastern United States and southern California.

METHODS

Medical records of 920 children who presented to the pediatric EDs with skin infections and abscesses (International Classification of Diseases, Ninth Revision codes 680.0-686.9) during 2003 were reviewed. Chronically ill children with previously described risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) were excluded. Data abstracted included the type of infection; the site of infection; and, if a culture was obtained, the organism grown, along with their corresponding sensitivities.

RESULTS

Of the 270 children who had bacterial cultures obtained, 60 (22%) were CA-MRSA-positive cultures, most cultured from abscesses (80%). Of all abscesses cultured, CA-MRSA grew in more than half (53%). All CA-MRSA isolates tested were sensitive to vancomycin, trimethoprim-sulfamethoxazole, rifampin, and gentamicin. One isolate at each center was resistant to clindamycin. The sensitivities at both institutions were similar.

CONCLUSIONS

The authors conclude that CA-MRSA is responsible for most abscesses and that the pattern of CA-MRSA infections in these geographically distant pediatric EDs is similar. These data suggest that optimal diagnostic and management strategies for CA-MRSA will likely be widely applicable if results from a larger, more collaborative study yield similar findings.

Community-acquired methicillin-resistant Staphylococcus aureus

Published data confirm that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in incidence in both urban and rural settings. The statistical risk is higher for athletes, military personnel, prison inmates, intravenous drug abusers, the homeless, children in daycare, and certain Native American groups, but the infections are by no means restricted to these populations. Roughly 85% of the infections involve the skin and subcutaneous tissue, with the most common presentations being an abscess or folliculitis. The typical associated gene cassette is quite small and codes only for methicillin resistance. Abscesses generally respond to drainage.

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should recognize groups at high risk for community-acquired MSRA infections and manage these infections appropriately.

Emerging Infections in Dermatology

Cutaneous infections are common in dermatology. They occur in all populations and all ages. This review will focus on 3 emerging infections encountered by dermatologists; community-acquired methicillin-resistant Staphylococcus aureus, Epstein-Barr virus infections, and the atypical mycobacterial infections. The background, clinical presentation, diagnosis, and treatment of each of the 3 infections will be discussed.