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Ong KM, Phillips MS, Peskin CS. A mathematical model and inference method for bacterial colonization in hospital units applied to active surveillance data for carbapenem-resistant enterobacteriaceae. PLoS One 2020; 15:e0231754. [PMID: 33180781 PMCID: PMC7660488 DOI: 10.1371/journal.pone.0231754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
Widespread use of antibiotics has resulted in an increase in antimicrobial-resistant microorganisms. Although not all bacterial contact results in infection, patients can become asymptomatically colonized, increasing the risk of infection and pathogen transmission. Consequently, many institutions have begun active surveillance, but in non-research settings, the resulting data are often incomplete and may include non-random testing, making conventional epidemiological analysis problematic. We describe a mathematical model and inference method for in-hospital bacterial colonization and transmission of carbapenem-resistant Enterobacteriaceae that is tailored for analysis of active surveillance data with incomplete observations. The model and inference method make use of the full detailed state of the hospital unit, which takes into account the colonization status of each individual in the unit and not only the number of colonized patients at any given time. The inference method computes the exact likelihood of all possible histories consistent with partial observations (despite the exponential increase in possible states that can make likelihood calculation intractable for large hospital units), includes techniques to improve computational efficiency, is tested by computer simulation, and is applied to active surveillance data from a 13-bed rehabilitation unit in New York City. The inference method for exact likelihood calculation is applicable to other Markov models incorporating incomplete observations. The parameters that we identify are the patient-patient transmission rate, pre-existing colonization probability, and prior-to-new-patient transmission probability. Besides identifying the parameters, we predict the effects on the total prevalence (0.07 of the total colonized patient-days) of changing the parameters and estimate the increase in total prevalence attributable to patient-patient transmission (0.02) above the baseline pre-existing colonization (0.05). Simulations with a colonized versus uncolonized long-stay patient had 44% higher total prevalence, suggesting that the long-stay patient may have been a reservoir of transmission. High-priority interventions may include isolation of incoming colonized patients and repeated screening of long-stay patients.
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Affiliation(s)
- Karen M. Ong
- New York University School of Medicine, New York, New York, United States of America
- Courant Institute of Mathematical Sciences, New York, New York, United States of America
- * E-mail:
| | - Michael S. Phillips
- New York University School of Medicine, New York, New York, United States of America
| | - Charles S. Peskin
- Courant Institute of Mathematical Sciences, New York, New York, United States of America
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Mitchell JJ, Jackson JM, Anwar A, Singleton SB. Bacterial Sport-Related Skin and Soft-Tissue Infections (SSTIs): An Ongoing Problem Among a Diverse Range of Athletes. JBJS Rev 2019; 5:01874474-201701000-00002. [PMID: 28135229 DOI: 10.2106/jbjs.rvw.16.00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Justin J Mitchell
- 1The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado2Division of Dermatology, University of Louisville, Louisville, Kentucky3CLn Skin Care, Top MD Skin Care, Dallas, Texas
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Mascaro V, Capano MS, Iona T, Nobile CGA, Ammendolia A, Pavia M. Prevalence of Staphylococcus aureus carriage and pattern of antibiotic resistance, including methicillin resistance, among contact sport athletes in Italy. Infect Drug Resist 2019; 12:1161-1170. [PMID: 31123413 PMCID: PMC6511236 DOI: 10.2147/idr.s195749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background and purpose: Athletes participating in contact or collision sports have a great chance of acquiring Staphylococcus aureus infections. The risk factors for colonization and infections include frequent antibiotic use, close contact situations, skin trauma, sharing of sports equipment, and poor hygiene. Therefore, our specific goals were to determine (1) prevalence of S. aureus among different types of contact sport athletes which were barely studied in the European region, (2) antimicrobial resistance of S. aureus isolates, and (3) association of carriage with particular risk factors of spor t practices. Patients and methods: A cross-sectional study was conducted among contact or collision sport athletes in Italy. A questionnaire was used to gather information about sociodemographic characteristics, specific sport activities, and participants’ health conditions. Swabs were collected from the nares, oropharynx, and fingers and tested for S. aureus isolation and antimicrobial susceptibility. Results:S. aureus was carried by 42% of 238 enrolled athletes. Colonization was associated with number of weekly training days, sharing of sports equipment, not taking a shower immediately after training, and a previous history of pharyngitis or sinusitis and skin manifestations. Isolates were resistant to clindamycin (24.8%) and erythromycin (15.8%). Of all athletes, 1.3% carried methicillin-resistant S. aureus (MRSA); MRSA were 3% of all S. aureus isolates. No strains were resistant to sulfamethoxazole/trimethoprim. Conclusion: Our results have shown a high prevalence of S. aureus carriage and a relevant resistance to antimicrobials used for the treatment of S. aureus infections. Prevention efforts aimed at reducing S. aureus colonization, and thus potentially reducing infections, should be improved.
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Affiliation(s)
- Valentina Mascaro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Simona Capano
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Teresa Iona
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
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High Occurrence of Staphylococcus aureus Isolated from Fitness Equipment from Selected Gymnasiums. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:4592830. [PMID: 30245728 PMCID: PMC6136567 DOI: 10.1155/2018/4592830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/17/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022]
Abstract
Introduction Staphylococcus aureus is a leading cause of cutaneous bacterial infection involving community. Methods In this study, a total of 42 swab samples were collected from the surface of various fitness equipment such as back machines, exercise mats, dip stations, dumbbells, and treadmills. Identification of the bacterial isolates was conducted using biochemical tests and further analysed molecularly using the PCR method targeting nuc gene (270 bp). The nuc gene encodes for the thermonuclease enzyme, a virulent factor of S. aureus. Results The findings showed 31 out of 42 swab samples (73.81%) were positive with S. aureus. Conclusion This study showed that gymnasium equipment is a potential reservoir for S. aureus and might play an important role in transmitting the pathogen to humans. Objective This study was undertaken to assess the presence of S. aureus on the surface of fitness equipment from selected gymnasiums in Kuching and Kota Samarahan, Sarawak (Malaysia).
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Alex A, Letizia M. Community-Acquired Methicillin-Resistant Staphylococcus aureus: Considerations for School Nurses. J Sch Nurs 2016; 23:210-3. [PMID: 17676968 DOI: 10.1177/10598405070230040501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a disease-causing organism that has been present in hospital settings since the 1960s. However, a genetically distinct strain of MRSA, called community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), has emerged in recent years in community settings among healthy individuals. While this organism has been found to be less resistant to antibiotics, it is also more virulent and capable of causing a spectrum of illnesses. School nurses must be aware of the risk factors for this infection and understand its signs, symptoms, diagnostic testing, and management. With this knowledge, school nurses can help protect students, staff, and community members from this increasingly prevalent pathogen.
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Affiliation(s)
- Aniltta Alex
- Loyola University Medical Center, Maywood, IL, USA
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de Souza CSM, Fortaleza CMCB, Witzel CL, Silveira M, Bonesso MF, Marques SA, Cunha MDLRDSD. Toxigenic profile of methicillin-sensitive and resistant Staphylococcus aureus isolated from special groups. Ann Clin Microbiol Antimicrob 2016; 15:9. [PMID: 26880287 PMCID: PMC4754922 DOI: 10.1186/s12941-016-0125-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Staphylococcus aureus is characterized by its pathogenicity and high prevalence, causing disease in both healthy and immunocompromised individuals due to its easy dissemination. This fact is aggravated by the widespread dissemination of S. aureus carrying toxigenic genes.
The objective of this study was to determine the toxigenic profile of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in patients with purulent skin and/or soft tissue infections seen at the Dermatology Department of the University Hospital of the Botucatu Medical School, asymptomatic adults older than 60 years living in nursing homes, and prison inmates of the Avaré Detention Center. Methods PCR was used for the detection of the mecA gene, enterotoxin genes (sea, seb, and sec), exfoliative toxins A and B (eta and etb), toxic shock syndrome toxin 1 (tst), panton–valentine leukocidin (lukS-PV and lukF-PV), and alpha- and delta-hemolysins or cytotoxins (hla and hld). Results The results showed a significant prevalence of toxigenic genes among S. aureus isolates from asymptomatic individuals, with the observation of a higher prevalence of cytotoxin genes. However, the panton–valentine leukocidin gene was only detected in MSSA isolated from patients with skin infections and the tst gene was exclusively found in MSSA isolated from prison inmates. Conclusions The present study demonstrated a significant prevalence of toxigenic genes in MSSA and MRSA strains isolated from asymptomatic S. aureus carriers. There was a higher prevalence of cytotoxin genes.
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Affiliation(s)
- Camila Sena Martins de Souza
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | | | - Claudia Lima Witzel
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Mônica Silveira
- Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Mariana Fávero Bonesso
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Silvio Alencar Marques
- Department of Dermatology and Radiology, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
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Gupta AK, Lyons DCA, Rosen T. New and emerging concepts in managing and preventing community-associated methicillin-resistantStaphylococcus aureusinfections. Int J Dermatol 2015; 54:1226-32. [DOI: 10.1111/ijd.13010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/09/2015] [Accepted: 02/15/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Aditya K. Gupta
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Mediprobe Research Inc.; London Ontario Canada
| | | | - Ted Rosen
- Baylor College of Medicine; Houston TX USA
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Mohammad H, Reddy PVN, Monteleone D, Mayhoub AS, Cushman M, Seleem MN. Synthesis and antibacterial evaluation of a novel series of synthetic phenylthiazole compounds against methicillin-resistant Staphylococcus aureus (MRSA). Eur J Med Chem 2015; 94:306-16. [PMID: 25771109 DOI: 10.1016/j.ejmech.2015.03.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/04/2015] [Accepted: 03/06/2015] [Indexed: 01/26/2023]
Abstract
Methicillin-resistant Staphylococcus aureus infections are a significant global health challenge in part due to the emergence of strains exhibiting resistance to nearly all classes of antibiotics. This underscores the urgent need for the rapid development of novel antimicrobials to circumvent this burgeoning problem. Previously, whole-cell screening of a library of 2,5-disubstituted thiazole compounds revealed a lead compound exhibiting potent antimicrobial activity against MRSA. The present study, conducting a more rigorous analysis of the structure-activity relationship of this compound, reveals a nonpolar, hydrophobic functional group is favored at thiazole-C2 and an ethylidenehydrazine-1-carboximidamide moiety is necessary at C5 for the compound to possess activity against MRSA. Furthermore, the MTS assay confirmed analogs 5, 22d, and 25 exhibited an improved toxicity profile (not toxic up to 40 μg/mL to mammalian cells) over the lead 1. Analysis with human liver microsomes revealed compound 5 was more metabolically stable compared to the lead compound (greater than eight-fold improvement in the half-life in human liver microsomes). Collectively the results presented demonstrate the novel thiazole derivatives synthesized warrant further exploration for potential use as future antimicrobial agents for the treatment of multidrug-resistant S. aureus infections.
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Affiliation(s)
- Haroon Mohammad
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN 47907, USA
| | - P V Narasimha Reddy
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, and the Purdue Center for Cancer Research, West Lafayette, IN 47907, USA
| | - Dennis Monteleone
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, and the Purdue Center for Cancer Research, West Lafayette, IN 47907, USA
| | | | - Mark Cushman
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, and the Purdue Center for Cancer Research, West Lafayette, IN 47907, USA
| | - Mohamed N Seleem
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN 47907, USA.
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Kahanov L, Kim YK, Eberman L, Dannelly K, Kaur H, Ramalinga A. Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in and around therapeutic whirlpools in college athletic training rooms. J Athl Train 2015; 50:432-7. [PMID: 25710853 DOI: 10.4085/1062-6050-49.3.96] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a leading cause of skin and soft tissue infection in the nonhospitalized community. Care of the athletes in athletic training rooms is specifically designed with equipment tailored to the health care needs of the athletes, yet recent studies indicate that CA-MRSA is still prevalent in athletic facilities and that cleaning methods may not be optimal. OBJECTIVE To investigate the prevalence of Staphylococcus aureus and CA-MRSA in and around whirlpools in the athletic training room. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I university. PATIENTS OR OTHER PARTICIPANTS Student-athletes (n = 109) consisting of 46 men (42%) and 63 women (58%) representing 6 sports. MAIN OUTCOME MEASURE(S) Presence of MRSA and Staphylococcus aureus in and around the whirlpool structures relative to sport and number of athletes using the whirlpools. RESULTS We identified Staphylococcus aureus in 22% (n = 52/240) of the samples and MRSA in 0.8% (n = 2/240). A statistically significant difference existed between the number of athletes using the whirlpool and the presence of Staphylococcus aureus in and around the whirlpools (F(2,238) = 2.445, P = .007). However, Staphylococcus aureus was identified regardless of whether multiple athletes used a whirlpool or no athletes used a whirlpool. We did not identify a relationship between the number of athletes who used a whirlpool and Staphylococcus aureus or MRSA density (P = .134). CONCLUSIONS Staphylococcus aureus and MRSA were identified in and around the whirlpools. Transmission of the bacteria can be reduced by following the cleaning and disinfecting protocols recommended by the Centers for Disease Control and Prevention. Athletic trainers should use disinfectants registered by the Environmental Protection Agency to sanitize all whirlpools between uses.
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Affiliation(s)
- Leamor Kahanov
- Indiana State University, Terre Haute. Dr Kahanov is now at College of Health Sciences, Misericordia University, Dallas, PA. Young Kyun Kim, MA, is now at Moungji University, Yong-in, South Korea
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Archibald LK, Shapiro J, Pass A, Rand K, Southwick F. Methicillin-Resistant Staphylococcus aureus Infection in a College Football Team: Risk Factors Outside the Locker Room and Playing Field. Infect Control Hosp Epidemiol 2015; 29:450-3. [DOI: 10.1086/587971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We investigated a cluster of methicillin-resistant Staphylococcus aureus infections in college football players. Risk factors included a history of recurrent skin infections and contact with the skin lesions of persons outside college. The infections were controlled through treatment of carriers with topical mupirocin, chlorhexidine body washes, and enhancement of personal hygiene practices. Varsity and professional teams need to consider similar preventive measures.
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Abstract
Methicillin-resistant Staphylococcus aureus has been a clinically significant pathogen in orthopaedics for more than a decade. Research shows that these infections are more virulent and that treatment requires greater use of hospital resources. A multidisciplinary approach involving emergency department physicians, radiologists, interventional radiologists, MRI technicians, pediatricians, infectious disease specialists, anesthesiologists, and orthopaedic surgeons is necessary to optimize outcomes and minimize costs. Early use of MRI helps delineate the extent of infection, aids in the consideration of surgery, and provides valuable information for surgical planning. Healthcare providers need to stay vigilant during the course of the disease to detect other sites of infection or complications of methicillin-resistant S aureus, such as deep vein thrombosis and septic pulmonary emboli. Patients with infections near growth centers require long-term monitoring to ensure the absence of growth disturbances. Physicians should help educate patients and families on prevention strategies and be aware of guidelines for students to return to school and athletes to return to play.
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Bandyopadhyay S, Junjie RL, Lim B, Sanjeev R, Xin WY, Yee CK, Hui Melodies SM, Yow N, Sivaraman J, Chatterjee C. Solution structures and model membrane interactions of Ctriporin, an anti-methicillin-resistantStaphylococcus aureusPeptide from Scorpion Venom. Biopolymers 2014; 101:1143-53. [DOI: 10.1002/bip.22519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/14/2014] [Accepted: 06/06/2014] [Indexed: 02/04/2023]
Affiliation(s)
| | | | - Brendan Lim
- School of Applied Science; Republic Polytechnic Singapore
| | - R. Sanjeev
- School of Applied Science; Republic Polytechnic Singapore
| | - Woon Yong Xin
- School of Applied Science; Republic Polytechnic Singapore
| | - Chong Kok Yee
- School of Applied Science; Republic Polytechnic Singapore
| | | | - Nicole Yow
- School of Applied Science; Republic Polytechnic Singapore
| | - J. Sivaraman
- Department of Biological Sciences; National University of Singapore; Singapore
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Bräuer SL, Vuono D, Carmichael MJ, Pepe-Ranney C, Strom A, Rabinowitz E, Buckley DH, Zinder SH. Microbial sequencing analyses suggest the presence of a fecal veneer on indoor climbing wall holds. Curr Microbiol 2014; 69:681-9. [PMID: 24972665 DOI: 10.1007/s00284-014-0643-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/06/2014] [Indexed: 01/22/2023]
Abstract
Artificial climbing walls represent a unique indoor environment in which humans interact closely with a variety of surface types. Climbing wall holds may mediate transmission of organisms between individuals, and yet there are no studies that identify microorganisms present on these surfaces. In the current study, the microorganisms found on climbing wall holds were characterized by analysis of amplified SSU rRNA gene sequences. In contrast to many other studies of built environments, the majority of microorganisms on holds were most closely related to microbes annotated as being recovered from environmental sources, such as soil, with human skin also representing an important source. Regional patterns were evident as rRNA gene sequences from the marine cyanobacterium Prochlorococcus were abundant in gyms found within 16 km of the ocean. Enterobacteriaceae were present on 100 % of holds surveyed, and the members detected are commonly associated with fecal matter.
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Affiliation(s)
- S L Bräuer
- Department of Biology, Appalachian State University, Boone, NC, 28608, USA,
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Emergence of new CMRSA7/USA400 methicillin-resistant Staphylococcus aureus spa types in Alberta, Canada, from 2005 to 2012. J Clin Microbiol 2014; 52:2439-46. [PMID: 24789179 DOI: 10.1128/jcm.00505-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most significant pathogens affecting global public health and health care systems. In Canada and the United States, the spread of MRSA is primarily attributed to a single dominant epidemic clone: CMRSA10/USA300. Despite this, the CMRSA7/USA400 epidemic clone has been reported to be the predominate epidemic clone in several Canadian provinces and some parts of the United States. This study examined the epidemiology of CMRSA7/USA400 MRSA in Alberta, Canada, from June 2005 to December 2012. Molecular characterization of CMRSA7/USA400 isolates was done using spa, SCCmec, PVL, and PFGE typing and identified two predominant spa types in Alberta: t128 and t1787. Although closely related, these spa types have distinct geographic distributions. From 2010 to 2012, the number of t128 infections has remained stable while there has been a nearly 3-fold increase in the number of provincial t1787 infections, accompanied by 10-fold increases in t1787 infection rates in some communities. Most t128 and t1787 patients were First Nations or Inuit people, and isolates were usually from skin and soft tissue infections in outpatients. t128 patients were significantly older than t1787 patients. Antimicrobial susceptibility testing showed higher mupirocin resistance in t1787 than in t128 MRSA. Improved strategies to reduce or stabilize t1787 infections in Alberta are needed.
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Cohen PR. Cutaneous community-acquired methicillin-resistantStaphylococcus aureusinfection: a personal perspective of a worldwide epidemic. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.1.5.631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Community-onset Staphylococcus aureus infections presenting to general practices in South-eastern Australia. Epidemiol Infect 2013; 142:501-11. [PMID: 23866772 DOI: 10.1017/s0950268813001581] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Community-acquired Staphylococcus aureus infections are a public health concern, yet little is known about infections that do not present to hospital. We identified community-onset S. aureus infections via specimens submitted to a community-based pathology service. Referring doctors confirmed eligibility and described infection site, severity and treatment. Isolates were characterized on antibiotic resistance, PFGE, MLST/SCCmec, and Panton-Valentine leukocidin (PVL), representing 106 community-onset infections; 34 non-multiresistant methicillin-resistant S. aureus (nmMRSA) (resistant to <3 non-β-lactam antibiotics), 15 multiply antibiotic-resistant MRSA (mMRSA) and 57 methicillin-sensitive S. aureus (MSSA). Most (93%) were skin and soft tissue infections. PVL genes were carried by 42% of nmMRSA isolates [95% confidence interval (CI) 26-61] and 15% of MSSA (95% CI 8-28). PVL was associated with infections of the trunk, head or neck (56·4% vs. 24·3%, P=0·005) in younger patients (23 vs. 52 years, P<0·001), and with boils or abscesses (OR 8·67, 95% CI 2·9-26·2), suggesting underlying differences in exposure and/or pathogenesis.
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Meddles-Torres C, Hu S, Jurgens C. Changes in prescriptive practices in skin and soft tissue infections associated with the increased occurrence of community acquired methicillin resistant Staphylococcus aureus. J Infect Public Health 2013; 6:423-30. [PMID: 23999333 DOI: 10.1016/j.jiph.2013.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Over 30% of the US population is colonized with methicillin resistant Staphylococcus aureus (MRSA). People within the community, without factors associated with Hospital Acquired (HA) MRSA, present with skin and soft tissue infections (SSTIs). Community Acquired MRSA (CA-MRSA) is resistant to antibiotics typically prescribed for SSTI. Many SSTIs are treated with antibiotics that are ineffective against drug resistant strains. STUDY OBJECTIVES This study examines the incidence of SSTIs associated with CA-MRSA, to determine if an increase in SSTI's is associated with changes in prescribing patterns for MRSA. METHODS A secondary analysis of the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) data was used to detect incidence of SSTIs based on ICD-9 coding between the periods of 1997-2002 and 2003-2008. Antibiotic prescribing patterns were examined for treatment. RESULTS Incidence of SSTIs increased by 84.7% from 1997-2002 to 2003-2008. Antibiotics prescribed for methicillin sensitive S. aureus decreased while treatment with MSRA antibiotics increased. CONCLUSION There is an increased incidence of SSTI within the community, suggesting that CA-MRSA may be a contributing factor. Health care providers are recognizing the increased incidence of CAMRSA, and are treating SSTI with appropriate antibiotics.
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Affiliation(s)
- Cheryl Meddles-Torres
- Biology Department, Queensborough Community College, 222-05 56th Avenue, M213, Bayside, NY 11364, USA.
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Kahanov L, Gilmore EJ, Eberman LE, Roberts J, Semerjian T, Baldwin L. Certified athletic trainers' knowledge of methicillin-resistant Staphylococcus aureus and common disinfectants. J Athl Train 2013; 46:415-23. [PMID: 21944074 DOI: 10.4085/1062-6050-46.4.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections. OBJECTIVE To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices. DESIGN Cross-sectional study. SETTING High school and collegiate athletic training rooms. PATIENTS OR OTHER PARTICIPANTS A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers' Association districts. MAIN OUTCOME MEASURE(S) Frequencies, analyses of variance, and χ(2) tests were used to assess current practices and opinions and relationships between factors. RESULTS Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ(2) test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ(2) test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete. CONCLUSIONS The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices.
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Affiliation(s)
- Leamor Kahanov
- Department of Applied Science and Rehabilitation, Indiana State University, Terre Haute, IN 47805, USA.
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Lagier L, Machet L, Poisson DM, Estève E. Épidémie de dermatophytoses chez les judokas du pôle France d’Orléans : étude prospective 2006/2011 et évaluation de l’efficacité des mesures instaurées en 2004/2005. Ann Dermatol Venereol 2012. [DOI: 10.1016/j.annder.2012.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gros C, Yazdanpanah Y, Vachet A, Roussel-Delvallez M, Senneville E, Lemaire X. Skin and soft tissue infections due to Panton-Valentine leukocidin producing Staphylococcus aureus. Med Mal Infect 2012; 42:488-94. [PMID: 23041372 DOI: 10.1016/j.medmal.2012.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 03/12/2012] [Accepted: 07/22/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The authors had for aim to describe the epidemiological and clinical characteristics, and the treatment of patients presenting with skin and soft tissue infections due to Panton-Valentine leukocidin (PVL) producing Staphylococcus aureus in the Nord-Pas-de-Calais (NPDC) region, North of France. METHODS We included patients presenting with PVL producing S. aureus infection from seven hospitals in the NPDC region, between February 2004 and April 2008. We retrospectively collected patient data using a standardized questionnaire. The features of patients presenting with skin and soft tissue were then analyzed. RESULTS PVL producing S. aureus was isolated from 64 patients. Fifty-four patients presented with skin and soft tissue infections. The mean age of patients was 23.8 years (63% male patients). The mean number of persons living with the infected patient was 4.5 (vs. 2.5 in NPDC). The lesions were abscesses with inflammatory signs in 64.8% of the cases (20% were necrotic). Among the patients, 70.3% carried a methicillin resistant strain. Antibiotics per os were used for 83.3% of patients; the first-line antibiotics were considered inadequate in 53.3% of the cases. Among the patients, 83.3% underwent surgery. Fourteen out of 38 patients with available data had been exposed to antibiotic therapy during the three months before hospital management. CONCLUSION Recent exposure to antibiotics and living with a high number of persons are reasons to suspect a PVL producing S. aureus infection in patients with skin abscess.
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Affiliation(s)
- C Gros
- Infectious diseases department, Dron hospital, Tourcoing, France
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Malachowa N, Kobayashi SD, DeLeo FR. Community-associated methicillin-resistant Staphylococcus aureus and athletes. PHYSICIAN SPORTSMED 2012; 40:13-21. [PMID: 22759601 DOI: 10.3810/psm.2012.05.1960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The remarkable ability of Staphylococcus aureus to develop antibiotic resistance in conjunction with the emergence of highly virulent and/or transmissible strains has established the pathogen as a leading cause of human bacterial infections worldwide. Historically, methicillin-resistant S aureus (MRSA) was found almost exclusively in hospitals and/or health care-related facilities. However, in the late 1990s, community-associated MRSA strains emerged in the United States and rapidly became the leading cause of community-associated bacterial infections. An enhanced understanding of the pathogenesis and epidemiology of this bacterium is fundamental for the prevention and/or treatment of community-associated MRSA infections. This review highlights salient features of S aureus biology that contribute to the exceptional ability of this pathogen to cause human disease, as well as discusses, in brief, the established approaches for treatment and prevention of infection.
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Affiliation(s)
- Natalia Malachowa
- Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institute of Health, Hamilton, MT 59840, USA.
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Fritz SA, Long M, Gaebelein CJ, Martin MS, Hogan PG, Yetter J. Practices and procedures to prevent the transmission of skin and soft tissue infections in high school athletes. J Sch Nurs 2012; 28:389-96. [PMID: 22472636 DOI: 10.1177/1059840512442899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Skin and soft tissue infections (SSTIs) are frequent in student athletes and are often caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We evaluated the awareness of CA-MRSA among high school coaches and athletic directors in Missouri (n = 4,408) and evaluated hygiene practices affecting SSTI transmission. Of 1,642 (37%) respondents, 61% received MRSA educational information during the past year and 32% indicated their school had written guidelines for managing SSTIs in athletes. Coaches and athletic directors aware of written guidelines reported a lower incidence of SSTIs in student athletes (26%) compared to those without written policies (34%, p = .03). When confronted with SSTIs, 49% of respondents referred student athletes to the school nurse or a physician. A relationship exists between school policies for SSTI management and lower incidence of SSTIs. Educational initiatives by school nurses in conjunction with athletic staff may lead to practices that limit SSTIs in this at-risk population.
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Affiliation(s)
- Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
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Abstract
MRSA is becoming increasingly common worldwide. With the emergence of new highly spreadable strains (community associated or CA-MRSA) novel presentation skin and soft tissue infections (SSTI) are being seen. Recurrent SSTI, including folliculitis, furunculosis and abscesses account for an increasing proportion of SSTI seen in the emergency department. Empirical antimicrobial management choices can be difficult, but clues to the nature of the MRSA may be gleaned from the history and clinical presentation. More severe SSTI due to necrotising fasciitis and purpura fulminans are emerging and warrant the broadest possible empirical Gram-positive cover, ideally with antimicrobials that stop exotoxin production, and sometimes intravenous immunoglobulin to neutralise exotoxins already produced.
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Affiliation(s)
- M Morgan
- Department of Microbiology, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.
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Hulterström AK, Sellin M, Berggren D. The microbial flora in the nasal septum area prone to perforation. APMIS 2011; 120:210-4. [PMID: 22339678 DOI: 10.1111/j.1600-0463.2011.02821.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To explore the colonizing bacterial flora of the nasal septum area, that is mostly afflicted by perforations, 101 healthy police students had swab samples taken from that location. The described culture strategy recovered positive cultures from 95% of the test subjects and from 60% with more than one organism. In total, 191 bacterial isolates were classified according to colony morphology, Gram-stain and a panel of standard laboratory techniques. A part of the bacteria was identified to species-level by biochemical methods and by sequencing of the 16S rRNA gene. The predominant finding was Gram-positive irregular rods - 65 presumptive Corynebacterium isolates, both lipophilic and non-lipophilic, and 37 anaerobic Propionibacterium isolates. The second largest bacterial group was Gram-positive catalase-positive cocci, of which 13 isolates were identified as Staphylococcus aureus and 53 as coagulase-negative staphylococci. The few potential airway pathogens included Streptococcus pneumonia (n = 1) and Moraxella catarrhalis (n = 3) isolates. The bacterial flora colonizing the nasal septum mainly consists of Gram-positive bacteria. Although of low virulence, the microbial flora may impact on occlusion treatment of nasal septum perforations with silicone obturators.
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Affiliation(s)
- Anna Karin Hulterström
- Department of Odontology/Dental Technicians Programme, Faculty of Medicine, Umeå University, Sweden.
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Blaivas M, Adhikari S. Unexpected findings on point-of-care superficial ultrasound imaging before incision and drainage. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1425-1430. [PMID: 21968495 DOI: 10.7863/jum.2011.30.10.1425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cutaneous abscesses are typically incised and drained on the basis of clinical assessment. In most cases this procedure is a safe practice. We report 6 cases in which point-of-care ultrasound interrogation of obvious abscesses revealed potential serious complications with planned incision and drainage. Management was altered in 5 of 6 cases, and potential vascular disasters were avoided. In 1 case, the ultrasound results were ignored, and incision and drainage was completed, confirming the suspected abscess was indeed a solid mass later diagnosed as a carcinoma. In this case series, point-of-care ultrasound interrogation provided rapid assessment and discovery of potentially catastrophic anatomic relationships, avoiding serious complications.
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Affiliation(s)
- Michael Blaivas
- Department of Emergency Medicine, North-side Hospital Forsyth, Cumming, GA 30041 USA.
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Ctriporin, a new anti-methicillin-resistant Staphylococcus aureus peptide from the venom of the scorpion Chaerilus tricostatus. Antimicrob Agents Chemother 2011; 55:5220-9. [PMID: 21876042 DOI: 10.1128/aac.00369-11] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Antibiotic-resistant microbes, such as methicillin-resistant Staphylococcus aureus, seriously threaten human health. The outbreak of "superbugs" in recent years emphasizes once again the need for the development of new antimicrobial agents or resources. Antimicrobial peptides have an evident bactericidal effect against multidrug-resistant pathogens. In the present study, a new antimicrobial peptide, ctriporin, was cloned and characterized from the venom of the scorpion Chaerilus tricostatus, an animal which has not yet been explored for toxic peptide resources. The MICs of ctriporin against Staphylococcus aureus, Bacillus thuringiensis, Bacillus subtilis, Micrococcus luteus, and Candida albicans are 5 to 20 μg/ml. Meanwhile, it MIC against clinical antibiotic-resistant bacterial strains is 10 μg/ml. Furthermore, the potential for ctriporin to be used as a topical antibiotic for treating staphylococcal skin infections was investigated. External use of the peptide ctriporin dramatically decreased the bacterial counts and cured skin infections in mice. In addition, ctriporin demonstrates antimicrobial efficacy via the bactericidal mechanism of rapid cell lysis. Together, these results suggest the potential of developing ctriporin as a new topical antibiotic.
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Larkin-Thier SM, Barber VA, Harvey P, Livdans-Forret AB. Community-acquired methicillin-resistant Staphylococcus aureus: a potential diagnosis for a 16-year-old athlete with knee pain. J Chiropr Med 2011; 9:32-7. [PMID: 21629397 DOI: 10.1016/j.jcm.2009.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 09/24/2009] [Accepted: 10/07/2009] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This case report aims to raise awareness in chiropractic physicians of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in adolescents who participate in sports activities and to alert the chiropractic physician of the necessity to consider potential diagnoses that are not within their typical clinical heuristic. CLINICAL FEATURES A 16-year-old adolescent girl entered the clinic with a complaint of left knee pain that had an insidious onset during her involvement in sports activities. Later that same day, her knee became enlarged, red, and had pustular formations with a discharge. She was taken to an urgent care facility and subsequently diagnosed with MRSA. Her history included treatment of a left knee musculoskeletal condition 6 weeks prior to which she had responded favorably. INTERVENTIONS AND OUTCOMES She was treated medically with an aggressive course of antibiotic therapy and excision of the furuncle. The chiropractic physician played a role in patient education and notifying local school authorities of the case. CONCLUSION Doctors of chiropractic must prepare themselves for the unexpected and remain open to diagnostic possibilities outside of the normal scope of practice. Knee pain or cellulitis of any type may require additional diagnostic and patient care protocols to make the correct diagnosis. With the incidence of community-acquired MRSA increasing at an alarming rate, it is certainly a diagnosis doctors of chiropractic should be aware of when treating patients, especially those involved in sports activities.
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WANINGER KEVINN, ROONEY THOMASP, MILLER JAMESE, BERBERIAN JEREMY, FUJIMOTO ALYSSA, BUTTARO BETTINAA. Community-Associated Methicillin-Resistant Staphylococcus aureus Survival on Artificial Turf Substrates. Med Sci Sports Exerc 2011; 43:779-84. [DOI: 10.1249/mss.0b013e3182006819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Oller AR, Province L, Curless B. Staphylococcus aureus recovery from environmental and human locations in 2 collegiate athletic teams. J Athl Train 2011; 45:222-9. [PMID: 20446834 DOI: 10.4085/1062-6050-45.3.222] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Staphylococcus aureus is spread via direct contact with persons and indirect contact via environmental surfaces such as weight benches. Athletes participating in direct-contact sports have an increased risk of acquiring S aureus infections. OBJECTIVE To determine (1) potential environmental reservoirs of S aureus in football and wrestling locker rooms and weight rooms, (2) environmental bacterial status after employing more stringent cleaning methods, (3) differences in colonization rates between athletes and nonathletes, (4) exposed body locations where Staphylococcus was recovered more frequently, and (5) personal hygiene practices of athletes and nonathletes. DESIGN Cross-sectional study. SETTING Locker room and strengthening and conditioning facilities at a National Collegiate Athletic Association Division II university. PATIENTS OR OTHER PARTICIPANTS Collegiate football players and wrestlers, with nonathlete campus residents serving as the control group. INTERVENTION(S) Infection control methods, education of the custodial staff, and education of the athletes regarding the Centers for Disease Control and Prevention guidelines for infection prevention. MAIN OUTCOME MEASURE(S) Cultures were taken from the participants' noses, fingertips, knuckles, forearms, and shoes and from the environment. RESULTS Before the intervention, from the 108 environmental samples taken from the football locker room and weight room, 26 (24%) contained methicillin-susceptible S aureus (MSSA) and 33 (31%) contained methicillin-resistant S aureus (MRSA). From the 39 environmental samples taken from the wrestling locker room and pit areas, 1 (3%) contained MSSA and 4 (10%) contained MRSA. The MRSA rates were different between the 2 locations according to a chi(2) test (P = .01). Seven MRSA isolates were recovered from football players and 1 from a wrestler; no MRSA isolates were recovered from the control group. The fingertip location of S aureus recovery from football players was significant when compared with both other locations in football players and fingertips in wrestlers and the control group (P < .05). Football players and wrestlers shared more personal items than the control group (P < .05). After the intervention, the football locker room and weight room samples were negative for S aureus. CONCLUSIONS Intact strengthening and conditioning equipment, proper hygiene, and proper disinfection methods lowered both environmental and human S aureus recovery at 1 university.
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Affiliation(s)
- Anna R Oller
- Department of Biology and Earth Science, University of Central Missouri, Warrensburg, MO 64093, USA.
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Barnes BE, Sampson DA. A literature review on community-acquired methicillin-resistant Staphylococcus aureus in the United States: Clinical information for primary care nurse practitioners. ACTA ACUST UNITED AC 2010; 23:23-32. [DOI: 10.1111/j.1745-7599.2010.00571.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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First Case Report of Primary Cutaneous Actinomycosis With Secondary Involvement of Bone. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181d2ee29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Creech CB, Saye E, McKenna BD, Johnson BG, Jimenez N, Talbot TR, Bossung T, Gregory A, Edwards KM. One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. ACTA ACUST UNITED AC 2010; 164:615-20. [PMID: 20603460 DOI: 10.1001/archpediatrics.2010.93] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the frequency and clinical importance of methicillin-resistant Staphylococcus aureus (MRSA) colonization in student athletes. DESIGN Prospective observational cohort study. SETTING A major university in the southeastern United States. PARTICIPANTS Student athletes participating in the men's football and women's lacrosse programs (N = 126). Main Exposure Monthly assessment of S aureus nasal colonization. MAIN OUTCOME MEASURES Trends in S aureus colonization over time and the occurrence of skin and soft tissue infections. RESULTS Methicillin-resistant S aureus nasal colonization varied significantly through the athletic season (4%-23%), peaking during times of highest athletic activity. This increase in colonization was not associated with the development of an outbreak of skin and soft tissue infections, and no single MRSA clone emerged as a dominant isolate. CONCLUSIONS During the athletic season, there is a considerable burden of MRSA colonization in student athletes; however, colonization alone appears to be insufficient to trigger an outbreak of staphylococcal infections. A combination of distinct molecular characteristics in the organism and specific host factors may govern the development of staphylococcal disease.
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Affiliation(s)
- C Buddy Creech
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Children's Hospital at Vanderbilt, Nashville, TN 37232-2573, USA.
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Stevens AM, Hennessy T, Baggett HC, Bruden D, Parks D, Klejka J. Methicillin-Resistant Staphylococcus aureus carriage and risk factors for skin infections, Southwestern Alaska, USA. Emerg Infect Dis 2010. [PMID: 20409369 PMCID: PMC2953982 DOI: 10.3201/eid1605.090851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Skin infection risk was increased among MRSA nasal carriers. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are common in southwestern Alaska. Outbreak strains have been shown to carry the genes for Panton-Valentine leukocidin (PVL). To determine if carriage of PVL-positive CA-MRSA increased the risk for subsequent soft tissue infection, we conducted a retrospective cohort study by reviewing the medical records of 316 persons for 3.6 years after their participation in a MRSA nasal colonization survey. Demographic, nasal carriage, and antimicrobial drug use data were analyzed for association with skin infection risk. Skin infections were more likely to develop in MRSA carriers than in methicillin-susceptible S. aureus carriers or noncarriers of S. aureus during the first follow-up year, but not in subsequent years. Repeated skin infections were more common among MRSA carriers. In an area where PVL-containing MRSA is prevalent, skin infection risk was increased among MRSA nasal carriers compared with methicillin-susceptible S. aureus carriers and noncarriers, but risk differential diminished over time.
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Affiliation(s)
- A Michal Stevens
- Centers for Disease Control and Prevention, Anchorage, Alaska 99508-5932, USA
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David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23:616-87. [PMID: 20610826 PMCID: PMC2901661 DOI: 10.1128/cmr.00081-09] [Citation(s) in RCA: 1340] [Impact Index Per Article: 95.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Michael Z David
- Department of Pediatrics and Department of Medicine, the University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637, USA.
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Stevens AM, Hennessy T, Baggett HC, Bruden D, Parks D, Klejka J. Methicillin-ResistantStaphylococcus aureusCarriage and Risk Factors for Skin Infections, Southwestern Alaska, USA. Emerg Infect Dis 2010; 16:797-803. [DOI: 10.3201/eid1605.091851] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Community-acquired methicillin-resistant Staphylococcus aureus in surgically treated hand infections. J Hand Surg Am 2010; 35:97-103. [PMID: 19962836 DOI: 10.1016/j.jhsa.2009.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 08/26/2009] [Accepted: 09/03/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE An increase in the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been observed. The purpose of this study is to determine the change in proportion of surgically treated CA-MRSA hand infections over the last decade and to identify associated risk factors. METHODS A retrospective review was performed of all 159 hand infections treated in the operating room over an 11-year period (1997-2007). Mean age overall was 40 years, mean inpatient length of stay was 4.9 days, and 115 of the 159 patients were male. Examined data included known risk factors for MRSA, including human immunodeficiency virus infection, diabetes mellitus, intravenous drug use, incarceration, and homelessness. RESULTS Forty-eight patients had surgery for hand infections due to CA-MRSA. The yearly proportion of CA-MRSA increased over the study period, and the risk of having an MRSA infection was 41% higher with each progressive calendar year during the study period relative to the apparent incidence of non-MRSA hand infections. Other factors associated with CA-MRSA were intravenous drug use, felon-type infection, and prior hand infection. Multivariable logistic regression identified intravenous drug use as a significant, independent risk factor for CA-MRSA hand infection. CONCLUSIONS The proportion of surgically treated hand infections due to CA-MRSA has increased during the last decade. Intravenous drug use was the only independent risk factor for CA-MRSA infections treated in the operating room at our institution.
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Witte W. Community-acquired methicillin-resistant Staphylococcus aureus: what do we need to know? Clin Microbiol Infect 2009; 15 Suppl 7:17-25. [DOI: 10.1111/j.1469-0691.2009.03097.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pappas G, Athanasoulia AP, Matthaiou DK, Falagas ME. Trimethoprim-sulfamethoxazole for methicillin-resistant Staphylococcus aureus: a forgotten alternative? J Chemother 2009; 21:115-26. [PMID: 19423463 DOI: 10.1179/joc.2009.21.2.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a growing infectious concern, mainly in the context of its rapid adaptation to novel antibiotic options for its treatment and the growing morbidity, mortality, and healthcare costs associated with its emergence. the authors sought to investigate whether an older antibiotic, such as trimethoprim-sulfamethoxazole (SXT), may have a role in treating MRSA-related infections, according to the available literature on the subject. The authors reviewed literature data on: resistance of MRSA to SXT worldwide in recent years, efficacy of SXT for MRSA decolonization or prophylaxis from MRSA infections, and clinical therapeutic efficacy of SXT in treating mild or severe community-acquired or hospital-acquired MRSA infections. Resistance varies worldwide, in general being low in the industrialized world and higher in developing countries. SXT is one of the numerous understudied options for MRSA decolonization and is growingly recognized as potentially effective in preventing MRSA infections in certain settings. Limited data on its therapeutic efficacy are encouraging, at least for mild, community-acquired infections. SXT may represent a cost-effective alternative weapon against MRSA. Its utility against this increasingly threatening pathogen need clarification through further clinical trials.
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Affiliation(s)
- G Pappas
- Institute of Continuing Medical Education of Ioannina, Greece.
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Buss BF, Mueller SW, Theis M, Keyser A, Safranek TJ. Population-Based Estimates of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Among High School Athletes—Nebraska, 2006–2008. J Sch Nurs 2009; 25:282-91. [DOI: 10.1177/1059840509333454] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of skin and soft-tissue infections among athletes. To determine statewide incidence among high school athletes, we surveyed all 312 Nebraska high schools regarding sport programs offered, program-specific participation numbers, number of athletes with physician-diagnosed MRSA infections, and athlete’s sport at infection onset. Among 271 (86.9%) schools responding, MRSA infections were reported among one or more athletes by 4.4% (12/270) and 14.4% (39/271) during school years 2006–2007 and 2007–2008, respectively. From 2006–2007 to 2007–2008, MRSA incidence per 10,000 wrestlers increased from 19.6 to 60.1, and incidence per 10,000 football players increased from 5.0 to 25.1. We did not identify differences in distribution of MRSA infections on the basis of grade, school enrollment, location, or number of participants per team. Incidence of reported MRSA infections among football players and wrestlers was substantially higher during 2007–2008, compared with 2006–2007.
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Taira BR, Singer AJ, Thode HC, Lee CC. National epidemiology of cutaneous abscesses: 1996 to 2005. Am J Emerg Med 2009; 27:289-92. [DOI: 10.1016/j.ajem.2008.02.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/01/2008] [Accepted: 02/15/2008] [Indexed: 10/21/2022] Open
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Community-Acquired Methicillin-Resistant Staphylococcus aureus: Diagnosis and Treatment Update for Plastic Surgeons. Plast Reconstr Surg 2008; 122:120e-127e. [DOI: 10.1097/prs.0b013e3181866d3f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Community-Acquired Methicillin Resistant Staphylococcus aureus in a Women’s Collegiate Basketball Team. South Med J 2008; 101:1067-8. [DOI: 10.1097/smj.0b013e318186b81c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Methicillin-resistant Staphylococcus aureus and athletes. J Am Acad Dermatol 2008; 59:494-502. [DOI: 10.1016/j.jaad.2008.04.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 03/28/2008] [Accepted: 04/03/2008] [Indexed: 01/22/2023]
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BOWERS ANDREAL, HUFFMAN GRUSSELL, SENNETT BRIANJ. Methicillin-Resistant Staphylococcus aureus Infections in Collegiate Football Players. Med Sci Sports Exerc 2008; 40:1362-7. [DOI: 10.1249/mss.0b013e31816f1534] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Levenhagen KM. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging concern for physical therapists: discussion. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2008; 13:9-17. [PMID: 18288766 DOI: 10.1002/pri.392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Centers for Disease Control has identified community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) as an emerging worldwide public health risk. Healthcare professionals such as physical therapists can play an important role in the early detection, prevention and management of CA-MRSA. This discussion paper is a narrative overview of CA-MRSA's prevalence in at-risk groups, the distinguishing characteristics of hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and CA-MRSA infections, and treatments for HA-MRSA and CA-MRSA. Using the Guide to Physical Therapist Practice as a framework, this paper describes physical therapists' role in the detection, prevention and management of CA-MRSA infections and their role in community education about CA-MRSA.
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Affiliation(s)
- Kim M Levenhagen
- Department of Physical Therapy, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall, Room 1026, St. Louis, MO 63104, USA.
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The skin in the gym: a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes. Clin Dermatol 2008; 26:16-26. [PMID: 18280900 DOI: 10.1016/j.clindermatol.2007.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is currently a problem of epidemic proportion. Athletes represent a specific group of individuals who are at increased risk to develop CAMRSA skin infections. In this article, the previously published reports of cutaneous CAMRSA infections in athletes are categorized by sport and summarized. General treatment guidelines for the management of cutaneous CAMRSA infection and its associated lesions in athletes are discussed. Also, recommendations for the prevention of CAMRSA skin infection in sports participants are reviewed.
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Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen in orthopaedics. J Am Acad Orthop Surg 2008; 16:98-106. [PMID: 18252840 DOI: 10.5435/00124635-200802000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Staphylococcus aureus (S aureus) remains one of the most common pathogens for skin and soft-tissue infections encountered by the orthopaedic surgeon. Community-acquired methicillin-resistant S aureus (CA-MRSA) has become increasingly prevalent, particularly among athletes, children in day care, homeless persons, intravenous drug users, men who have sex with men, military recruits, certain minorities (ie, Alaskan Natives, Native Americans, Pacific Islanders), and prison inmates. Risk factors include antibiotic use within the preceding year, crowded living conditions, compromised skin integrity, contaminated surfaces, frequent skin-to-skin contact, shared items, and suboptimal cleanliness. When a patient presents with a skin or soft-tissue infection, the clinician should determine whether an abscess or other infection needs to be surgically incised and drained. Cultures should be performed. When the patient is a member of an at-risk group or has any of the risk factors for CA-MRSA, beta-lactam antibiotics (eg, methicillin) are no longer a reasonable choice for treatment. Empiric treatment should consist of non-beta-lactam antibiotics active against CA-MRSA.
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Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infections: implications for patients and practitioners. Am J Clin Dermatol 2008; 8:259-70. [PMID: 17902728 DOI: 10.2165/00128071-200708050-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Dermatologists and other healthcare providers need to be aware of the epidemiology, clinical features, management, and prevention of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection. Currently, infection caused by CAMRSA is considered to represent a worldwide epidemic and infectious skin lesions are a frequent occurrence. Athletes, certain ethnic populations, children, homeless persons, homosexual men, household members of infected people, HIV-infected patients, intravenous drug abusers, military personnel, newborns, pregnant and postpartum women, tattoo recipients, and urban dwellers of lower socioeconomic status in crowded living conditions are individuals at increased risk of developing CAMRSA infection. Although the observed incidence of cutaneous CAMRSA lesions in patients with atopic dermatitis or other conditions that are characterized by a non-intact skin barrier is less than that reported in other groups of people at risk for this skin infection, close surveillance for the emergence of CAMRSA skin infection in children and adults with atopic dermatitis and other patients whose skin barrier is disrupted is justified since colonization by S. aureus in these individuals represents a potential reservoir for CAMRSA. It is also important to note that infection-associated risk factors are absent in many individuals who develop cutaneous CAMRSA infection. CAMRSA skin lesions are pleomorphic. The most common presentations of CAMRSA infection are abscess, cellulitis, or both. These infectious lesions are not uncommonly misinterpreted by the patient as spider bites or insect bites. Other manifestations of cutaneous CAMRSA infection are impetigo, folliculitis, and paronychia. Incision and drainage of abscesses, systemic antibacterial therapy, and adjunctive topical antibacterial treatment are the essential components of management of CAMRSA skin infections. At the initial visit, a bacterial culture of the infectious lesion is recommended to confirm identification of the pathogen and to determine antimicrobial susceptibility. Subsequently, based upon the reported antibacterial sensitivity, alteration (if necessary) of the patient's empiric systemic antimicrobial treatment can be initiated. Direct skin-to-skin transmission of the causative bacteria, damage to the skin's surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of CAMRSA skin infection. The spread of cutaneous CAMRSA infection can potentially be prevented by incorporating personal, environmental, and healthcare measures that strive to eliminate the causes of acquisition and transmission of the bacteria.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, University of Houston, Houston, Texas, USA.
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Cohen PR. Commentary to "Sports dermatology "illustrated": Why I do it, how I do it, and what about you?". Clin Dermatol 2007; 25:629. [PMID: 18021902 DOI: 10.1016/j.clindermatol.2007.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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O'Connor A, Loughrey A, Millar BC, Lowery CJ, Dooley JSG, Goldsmith CE, Rooney PJ, Moore JE. Lack of occurrence of methicillin-resistant Staphylococcus aureus on municipal public telephones. Am J Infect Control 2007; 35:285-6. [PMID: 17483003 DOI: 10.1016/j.ajic.2006.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 09/22/2006] [Indexed: 11/23/2022]
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