Acute rise in methicillin-resistant Staphylococcus aureus infections in a coastal community

Environmental Surveillance and Characterization of Antibiotic Resistant Staphylococcus aureus at Coastal Beaches and Rivers on the Island of Hawai'i

Staphylococcus aureus are human facultative pathogenic bacteria and can be found as contaminants in the environment. The aim of our study was to determine whether methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolated from coastal beach and river waters, anchialine pools, sand, and wastewater on the island of Hawaiʻi, Hawaiʻi, are a potential health risk. Samples were collected from three regions on Hawaiʻi Island from July to December 2020 during the COVID-19 pandemic and were characterized using whole-genome sequencing (WGS). From WGS data, multilocus sequence typing (MLST), SCCmec type, antimicrobial resistance genes, virulence factors, and plasmids were identified. Of the 361 samples, 98.1% were positive for Staphylococcus spp. and 7.2% were S. aureus positive (n = 26); nine MRSA and 27 MSSA strains were characterized; multiple isolates were chosen from the same sample in two sand and seven coastal beach water samples. The nine MRSA isolates were multi-drug resistant (6–9 genes) sequence type (ST) 8, clonal complex (CC) 8, SCCmec type IVa (USA300 clone), and were clonally related (0–16 SNP differences), and carried 16–19 virulence factors. The 27 MSSA isolates were grouped into eight CCs and 12 STs. Seventy-eight percent of the MSSA isolates carried 1–5 different antibiotic resistance genes and carried 5–19 virulence factors. We found S. aureus in coastal beach and river waters, anchialine pools, and sand at locations with limited human activity on the island of Hawaiʻi. This may be a public health hazard.

Methicillin‐resistant Staphylococcus aureus in acute otitis externa

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Study design

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Level of Evidence

Postoperation of preauricular fistula cellulitis caused by methicillin-resistant staphylococcus aureus infection

A one-year-old baby girl with one-month history of recurrent pus fluid exuding from her left preauricular sinus orifice, who failed multiple courses of surgical drainage of the abscess and persistent debridement for the wound, presented with MRSA infection. The patient was treated with linezolid for three days. Her pain and paresthesia resolved, and C-reactive protein decreased to normal.

Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) at ambient freshwater beaches

Methicillin-resistant Staphylococcus aureus (MRSA) are a threat to human health worldwide, and although detected at marine beaches, they have been largely unstudied at freshwater beaches. Genes indicating S. aureus (SA; femA) and methicillin resistance (mecA) were detected at 11 and 12 of 13 US Great Lakes beaches and in 18% or 27% of 287 recreational water samples, respectively. Eight beaches had mecA+femA (potential MRSA) detections. During an intensive study, higher bather numbers, staphylococci concentrations, and femA detections were found in samples collected after noon than before noon. Local population density, beach cloud cover, and beach wave height were significantly correlated with SA or MRSA detection frequency. The Panton-Valentine leukocidin gene, associated with community-acquired MRSA, was detected in 12 out of 27 potential MRSA samples. The femA gene was detected less frequently at beaches that met US enterococci criteria or EU enterococci 'excellent' recreational water quality, but was not related to Escherichia coli-defined criteria. Escherichia coli is often the only indicator used to determine water quality at US beaches, given the economic and healthcare burden that can be associated with infections caused by SA and MRSA, monitoring of recreational waters for non-fecal bacteria such as staphylococci and/or SA may be warranted.

Community-acquired methicillin-resistant Staphylococcus aureus nasal abscesses in a lower socioeconomic urban population

BACKGROUND

To determine the prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) and methicillin-sensitive S. aureus (MSSA) nasal abscesses in a lower socioeconomic status urban population over a 5-year period.

METHODS

A retrospective chart review of 29 consecutive patients with nasal abscess cultures performed in the otolaryngology clinic from 2007 to 2012.

RESULTS

Twenty-nine cases of nasal abscesses were identified. All cultures grew S. aureus; 34.5% were MSSA and 65.5% were CA-MRSA. Comparing CA-MRSA and MSSA, there was no statistically significant increase in prevalence of CA-MRSA over 5 years; and there was no statistical difference comparing gender, year, or age. There was a high rate of erythromycin resistance (15/19) and a low rate of sulfamethoxazole/trimethoprim (2/19) and clindamycin (1/19) resistance in the CA-MRSA cases.

CONCLUSION

In this population, the proportion of CA-MRSA nasal abscesses is nearly twice that of MSSA nasal abscesses. The overall prevalence of CA-MRSA appears to be stable over the past 5 years. This may represent a stabilization of CA-MRSA colonization in this community. An awareness of the high proportion of CA-MRSA will allow for the appropriate selection of antibiotic therapy.

Community-acquired methicillin-resistant Staphylococcus aureus in nasal vestibular abscess

BACKGROUND

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is a recognized entity that is increasingly responsible for skin and soft tissue infections. However, it is not the usual pathogen isolated in nasal vestibular abscess.

METHODS

We present a series of 13 consecutive patients presenting to a tertiary care center with nasal vestibular abscess over a 2.5-year period.

RESULTS

All abscesses were cultured and 100% (13/13) grew S. aureus. Of the S. aureus isolates, 92% (12/13) were MRSA. Antibiotic susceptibilities of the MRSA isolates were as follows: 100% were susceptible to rifampin, trimethoprim-sulfamethoxazole, and tetracycline, 75% to clindamycin, 58% to fluoroquinolones, and 17% to erythromycin.

CONCLUSION

MRSA is an important pathogen in the community. It is therefore critical to appreciate its potential predominance in nasal vestibular abscess. Clinicians should obtain cultures, modify antibiotic therapy as warranted, and initiate empiric therapy to include MRSA coverage for nasal vestibular abscess.

Head and neck ultrasound in the pediatric population

Ultrasound, as a diagnostic modality, has been developing rapidly. High-resolution ultrasound machines have been reduced to the size of a laptop computer. Ultrasound can be adopted by otolaryngologists for use within the clinic and the operating room. Ultrasound offers several advantages to the pediatric patient population. It is well tolerated and adds a degree of precision to the physical examination. It can be done repeatedly as lesions evolve and treatment is performed. It is valuable for guidance and therapeutic treatment of lesions in the operating room. It is likely that ultrasound use will continue to rapidly grow and evolve as a tool within the field of otolaryngology.

Methicillin-resistant Staphylococcus aureus laryngitis

Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have become more prevalent, in part because of the emergence and spread of community-acquired MRSA. This trend is particularly concerning because of the significant rates of morbidity and mortality associated with MRSA infections, and because MRSA strains are often resistant to many classes of antibiotics. Reports of infections of the head and neck, including wound infections, cellulitis, sinusitis, otitis media, and otitis externa, are well documented. However, to our knowledge, there have been no reports of bacterial laryngitis due to MRSA. We report the first published case of bacterial laryngitis caused by MRSA.

Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic

Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

Community-associated methicillin-resistant Staphylococcus aureus infections at an Army training installation

To assess the burden of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a high-risk population, the monthly incidence of laboratory-confirmed MRSA in service members/trainees stationed at Fort Benning, Georgia, USA without hospitalization or surgery documented 30 days prior to infection was calculated for calendar years 2002–2007. Clinical management and antibiotic susceptibility patterns were also evaluated. By 2007, ~67% of S. aureus strains were MRSA, and ~82% of these were community-associated, primarily in trainees. In total, 3531 CA-MRSA infections were identified. Rates appeared to be seasonal, peaking at 42 cases/1000 soldiers in 2005, with rates remaining above 35/1000 soldiers thereafter. Increased prescription of effective antibiotics was documented. Susceptibility to clindamycin, ciprofloxacin, and levofloxacin decreased from 2002 to 2007 by 6%, 17%, and 14%, respectively. The sustained high prevalence of CA-MRSA observed highlights the need for more vigilant population-based counter-measures at military training installations.

Role of methicillin-resistant Staphylococcus aureus in head and neck infections

The prevalence of infection with methicillin-resistant Staphylococcus aureus is increasing. Methicillin-resistant Staphylococcus aureus is also being recognised as an important pathogen in head and neck infections. This review summarises studies published over the past two decades which illustrate the growing prevalence of methicillin-resistant Staphylococcus aureus, and the current therapeutic approaches to head and neck infections caused by this bacterium. These infections include sinusitis, otitis, periorbital cellulitis, cervical lymphadenitis, tonsillitis, thyroiditis, retropharyngeal abscess, and abscesses and wounds of the neck. Treatment of head and neck infections associated with methicillin-resistant Staphylococcus aureus includes drainage and debridement, as well as administration of local and systemic antimicrobials that provide coverage against these organisms and against potential aerobic and anaerobic pathogens that may be present if the infection is polymicrobial.

The effect of media attention on concern for and medical management of methicillin-resistant Staphylococcus aureus: a multimethod study

BACKGROUND

Reports of an increase in the incidence and severity of methicillin-resistant Staphylococcus aureus (MRSA) infections provoked widespread media attention in October 2007. This study attempted to determine whether this widespread media attention led to changes in physician practices related to skin infections.

DESIGN

Data collection via LexisNexis, Central New York (CNY) microbiologic laboratory records, publicly available data on Internet search activity, and a survey of CNY healthcare providers allowed for examination of concurrent trends in media attention, public information-seeking behavior, and physician response.

RESULTS

During the period of October 15-29, 2007, a roughly 10-fold increase in the number of newspaper and television news broadcasts mentioning "MRSA" and "staph" coincided with a six-to eightfold increase in Internet search activity for the terms "MRSA" and "staph" and a 79 percent increase in provider-reported patient concern with MRSA. In addition, providers reported more frequent orders for cultures and prescription of antibiotics since then. Practices serving urban or low socioeconomic status patients tended to see less MRSA-related concern and activity, indicating a potential disparity in penetration of MRSA information into different populations.

CONCLUSIONS

Increased media coverage of MRSA coincided with increased public information-seeking behavior. Self-reported survey data demonstrate that this period was associated with a change in healthcare provider practice, and a concomitant twofold increase in the number of outpatient skin and soft tissue cultures reinforces this link. However, increased public attention appears not to have penetrated urban, less-affluent areas, raising questions about how quickly healthcare information penetrates different patient populations.

Current bacteriology of suppurative otitis: resistant patterns and outcomes analysis

INTRODUCTION

Antibiotic resistance has complicated the management of the draining ear. In this study, we examine the factors predisposing to resistance, as well as the role culture played in the management of these patients.

MATERIALS AND METHODS

A retrospective chart review was performed on all patients with a complaint of otorrhea during a 3-year period. Demographic factors, the patients diagnosis, previous antimicrobial use, the organism isolated, the resistance pattern of the organism, the treatment instituted, the treatment changed, and the efficacy of treatment were all examined.

RESULTS

Previous antibiotic use resulted in a significantly increased rate of resistance only for the diagnosis of otitis externa (p = 0.01). No other factors were found to be clinically significant. The previous use of ototopical quinolones was shown to be correlated with a significant increase in quinolone resistance (p = 0.01). Methicillin-resistant Staphylococcus aureus isolated was shown to have 60% and 33% resistance rates to clindamycin and trimethoprim/sulfamethoxazole, respectively. The overall treatment failure rate was 36% but rose to 50% for infections involving highly resistant bacteria (p = 0.01). Treatment was changed based on culture results in 21% of cases.

CONCLUSION

Previous antibiotic use is correlated with increased bacterial resistance in the case of otitis externa. Highly resistant bacteria were associated with an increased rate of treatment failure. Culture plays an essential role in the management of refractory otorrhea.

Staphylococcus aureus: a community pathogen

Staphylococcus aureus is a common human pathogen. S aureus infections most commonly clinically manifest as skin infections. There has been much interest in S aureus infections in the community over the past decade because of the rise of community-associated methicillin-resistant S aureus (CA-MRSA) infections, which have emerged globally over a relatively short period of time. In contrast to health care-associated methicillin resistant S aureus (HA-MRSA), circulating strains of CA-MRSA have characteristic pathogenesis, strain characteristics, epidemiology, and clinical manifestations that are distinct from HA-MRSA. In fact, CA-MRSA probably behaves more like community-associated methicillin-sensitive S aureus (MSSA). This article reviews current knowledge of the epidemiology and clinical manifestations of community-associated S aureus and CA-MRSA infections.