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Non L, Kosmin A. Fulminant necrotising fasciitis by community-acquired methicillin-resistant Staphylococcus aureus. BMJ Case Rep 2015; 2015:bcr-2014-206848. [PMID: 25824286 DOI: 10.1136/bcr-2014-206848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare cause of necrotising fasciitis (NF), and is usually not fulminant as in group A Streptococcus (GAS), the archetypal aetiology. We report an unusually fulminant case of NF by CA-MRSA in an immunocompetent patient. A 52-year-old man presented to the emergency department with 1 week of progressive left thigh pain and swelling. The patient had ecchymoses, bullae and hypoesthesia of the involved skin, and CT scan revealed extensive fascial oedema. He was immediately started on broad spectrum antibiotics. Within 12 h of presentation, he underwent surgical debridement. Despite aggressive supportive care, the patient died less than 24 h after presentation. MRSA, with an antibiogram suggestive of a community-acquired strain, was recovered from intraoperative specimens and admission blood cultures. This case underscores that CA-MRSA, while rarely reported, can cause a fulminant presentation of NF similar to GAS in immunocompetent patients.
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Affiliation(s)
- Lemuel Non
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Aaron Kosmin
- Department of Infectious Diseases, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
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Oosthuysen WF, Orth H, Lombard CJ, Sinha B, Wasserman E. Population structure analyses of Staphylococcus aureus at Tygerberg Hospital, South Africa, reveals a diverse population, a high prevalence of Panton-Valentine leukocidin genes, and unique local methicillin-resistant S. aureus clones. Clin Microbiol Infect 2013; 20:652-9. [PMID: 24206111 DOI: 10.1111/1469-0691.12452] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 11/29/2022]
Abstract
Studies reporting on the population structure of Staphylococcus aureus in South Africa have focused only on methicillin-resistant S. aureus (MRSA). This study describes the population structure of S. aureus, including methicillin-susceptible S. aureus (MSSA) isolated from patients at Tygerberg Academic Hospital, Western Cape province. Pulsed-field gel electrophoresis (PFGE), detection of Panton-Valentine leukocidin (PVL), spa typing, multilocus sequence typing (MLST), agr typing and SCCmec typing were used to characterize strains. Of 367 non-repetitive S. aureus isolates collected over a period of 1 year, 56 (15.3%) were MRSA. Skin and soft tissue infections were the most frequent source (54.8%), followed by bone and joint (15.3%) and respiratory tract infections (7.7%). For strain typing, PFGE was the most discriminative method, and resulted in 31 pulsotypes (n = 345, 94.0%), as compared with 16 spa clonal complexes (CCs) (n = 344, 93.4%). Four MLST CCs were identified after eBURST of sequence types (STs) of selected isolates. One hundred and sixty isolates (MSSA, n = 155, 42.2%) were PVL-positive, and agr types I-IV and SCCmec types I-V were identified. Our S. aureus population consisted of genotypically diverse strains, with PVL being a common characteristic of MSSA. MSSA and MRSA isolates clustered in different clones. However, the dominant MRSA clone (ST612) also contained an MSSA isolate, and had a unique genotype. Common global epidemic MRSA clones, such as ST239-MRSA-III and ST36-MRSA-II, were identified. A local clone, ST612-MRSA-IV, was found to be the dominant MRSA clone.
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Affiliation(s)
- W F Oosthuysen
- Division of Medical Microbiology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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3
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Chatterjee SS, Otto M. Improved understanding of factors driving methicillin-resistant Staphylococcus aureus epidemic waves. Clin Epidemiol 2013; 5:205-17. [PMID: 23861600 PMCID: PMC3707418 DOI: 10.2147/clep.s37071] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most important causes of nosocomial infections worldwide. Since the global spread of MRSA in the 1960s, MRSA strains have evolved with increased pathogenic potential. Notably, some strains are now capable of causing persistent infections not only in hospitalized patients but also in healthy individuals in the community. Furthermore, MRSA is increasingly associated with infections among livestock-associated workers, primarily because of transmission from animals to humans. Moreover, many MRSA strains have gained resistance to most available antibiotics. In this review, we will present current knowledge on MRSA epidemiology and discuss new endeavors being undertaken to understand better the molecular and epidemiological underpinnings of MRSA outbreaks.
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Affiliation(s)
- Som S Chatterjee
- Pathogen Molecular Genetics Section, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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Shadyab AH, Crum-Cianflone NF. Methicillin-resistant Staphylococcus aureus (MRSA) infections among HIV-infected persons in the era of highly active antiretroviral therapy: a review of the literature. HIV Med 2012; 13:319-32. [DOI: 10.1111/j.1468-1293.2011.00978.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 11/27/2022]
Affiliation(s)
- AH Shadyab
- Graduate School of Public Health; San Diego State University; San Diego; CA; USA
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Steckel H, Baums MH, Tennstedt-Schenk C, Klinger HM. Necrotizing fasciitis of the knee following primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:2076-9. [PMID: 21647659 DOI: 10.1007/s00167-011-1561-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 05/19/2011] [Indexed: 10/24/2022]
Abstract
Necrotizing fasciitis is a rare, life-threatening and rapidly spreading soft-tissue infection that results in necrosis of the muscle, fascia and surrounding tissue. It can be result of a polymicrobial synergistic infection or a streptococcal infection. The authors report a case of necrotizing fasciitis occurring in the knee of a 65-year-old woman following an uneventful primary total knee arthroplasty and resulting in above-the-knee amputation. Having in mind severe infections like necrotising fasciitis, one should be aware of the possibility of such postoperative complications especially in patients with risk factors even in routine procedures like a total knee arthroplasty.
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Abstract
With four types of necrotizing fasciitis (NF) now recognized, the diagnosis and management of NF becomes more challenging as physicians face more unusual pathogenic and atypical presentations. With few published guidelines and little evidence base to justify therapies, much of the literature is pragmatic or provides limited evidence with small underpowered studies and disparate case reports.
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Affiliation(s)
- Marina S Morgan
- Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK,
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Severe myelosuppression and MRSA infection as the presentation of perinatal HIV infection. Pediatr Infect Dis J 2011; 30:727-8. [PMID: 21750452 DOI: 10.1097/inf.0b013e31821e8b36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Morikawa K, Okada F, Ando Y, Ishii R, Matsushita S, Ono A, Maeda T, Mori H, Yamashita S, Kawahara K. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible S. aureus pneumonia: comparison of clinical and thin-section CT findings. Br J Radiol 2011; 85:e168-75. [PMID: 21750126 DOI: 10.1259/bjr/65538472] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The purpose of this study was to compare the clinical and thin-section CT findings in patients with meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-susceptible S. aureus (MSSA). METHODS We retrospectively identified 201 patients with acute MRSA pneumonia and 164 patients with acute MSSA pneumonia who had undergone chest thin-section CT examinations between January 2004 and March 2009. Patients with concurrent infectious disease were excluded from our study. Consequently, our study group comprised 68 patients with MRSA pneumonia (37 male, 31 female) and 83 patients with MSSA pneumonia (32 male, 51 female). Clinical findings in the patients were assessed. Parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed. RESULTS Underlying diseases such as cardiovascular were significantly more frequent in the patients with MRSA pneumonia than in those with MSSA pneumonia. CT findings of centrilobular nodules, centrilobular nodules with a tree-in-bud pattern, and bronchial wall thickening were significantly more frequent in the patients with MSSA pneumonia than those with MRSA pneumonia (p = 0.038, p = 0.007 and p = 0.039, respectively). In the group with MRSA, parenchymal abnormalities were observed to be mainly peripherally distributed and the frequency was significantly higher than in the MSSA group (p = 0.028). Pleural effusion was significantly more frequent in the patients with MRSA pneumonia than those with MSSA pneumonia (p = 0.002). CONCLUSIONS Findings from the evaluation of thin-section CT manifestations of pneumonia may be useful to distinguish between patients with acute MRSA pneumonia and those with MSSA pneumonia.
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Affiliation(s)
- K Morikawa
- Department of Radiology, Oita University Faculity of Medicine, Oita, Japan
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Hidron AI, Kempker R, Moanna A, Rimland D. Methicillin-resistant Staphylococcus aureus in HIV-infected patients. Infect Drug Resist 2010; 3:73-86. [PMID: 21694896 PMCID: PMC3108732 DOI: 10.2147/idr.s7641] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Indexed: 01/09/2023] Open
Abstract
Concordant with the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community setting, colonization and infections with this pathogen have become a prevalent problem among the human immunodeficiency virus (HIV)-positive population. A variety of different host- and, possibly, pathogen-related factors may play a role in explaining the increased prevalence and incidence observed. In this article, we review pathophysiology, epidemiology, clinical manifestations, and treatment of MRSA in the HIV-infected population.
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Morgan M. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 2010; 75:249-57. [DOI: 10.1016/j.jhin.2010.01.028] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 01/13/2010] [Indexed: 01/22/2023]
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Yamamoto T, Nishiyama A, Takano T, Yabe S, Higuchi W, Razvina O, Shi D. Community-acquired methicillin-resistant Staphylococcus aureus: community transmission, pathogenesis, and drug resistance. J Infect Chemother 2010; 16:225-54. [PMID: 20336341 PMCID: PMC7088255 DOI: 10.1007/s10156-010-0045-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Indexed: 11/29/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is able to persist not only in hospitals (with a high level of antimicrobial agent use) but also in the community (with a low level of antimicrobial agent use). The former is called hospital-acquired MRSA (HA-MRSA) and the latter community-acquired MRSA (CA-MRSA). It is believed MRSA clones are generated from S. aureus through insertion of the staphylococcal cassette chromosome mec (SCCmec), and outbreaks occur as they spread. Several worldwide and regional clones have been identified, and their epidemiological, clinical, and genetic characteristics have been described. CA-MRSA is likely able to survive in the community because of suitable SCCmec types (type IV or V), a clone-specific colonization/infection nature, toxin profiles (including Pantone-Valentine leucocidin, PVL), and narrow drug resistance patterns. CA-MRSA infections are generally seen in healthy children or young athletes, with unexpected cases of diseases, and also in elderly inpatients, occasionally surprising clinicians used to HA-MRSA infections. CA-MRSA spreads within families and close-contact groups or even through public transport, demonstrating transmission cores. Re-infection (including multifocal infection) frequently occurs, if the cores are not sought out and properly eradicated. Recently, attention has been given to CA-MRSA (USA300), which originated in the US, and is growing as HA-MRSA and also as a worldwide clone. CA-MRSA infection in influenza season has increasingly been noted as well. MRSA is also found in farm and companion animals, and has occasionally transferred to humans. As such, the epidemiological, clinical, and genetic behavior of CA-MRSA, a growing threat, is focused on in this study.
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Affiliation(s)
- Tatsuo Yamamoto
- Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Olsen RJ, Musser JM. Molecular pathogenesis of necrotizing fasciitis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2010; 5:1-31. [PMID: 19737105 DOI: 10.1146/annurev-pathol-121808-102135] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Necrotizing fasciitis, also known as the flesh-eating disease, is a severe invasive infection associated with very high rates of human morbidity and mortality. It is most commonly caused by group A Streptococcus(GAS), a versatile human pathogen that causes diseases ranging in severity from uncomplicated pharyngitis (or strep throat) to life-threatening infections such as necrotizing fasciitis. Herein, we review recent discoveries bearing on the molecular pathogenesis of GAS necrotizing fasciitis. Importantly, the integration of new technologies and the development of human-relevant animal models have markedly expanded our understanding of the key pathogen-host interactions underlying GAS necrotizing fasciitis. For example, we now know that GAS organisms secrete a variety of proteases that disrupt host tissue and that these proteolytic enzymes are regulated by multiple transcriptional and posttranslational processes. This pathogenesis knowledge will be crucial to supporting downstream efforts that seek to develop novel vaccines and therapeutic agents for this serious human infection.
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Affiliation(s)
- Randall J Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, The Methodist Hospital Research Institute, and Department of Pathology, The Methodist Hospital, Houston, Texas 77030, USA
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Abstract
Severe skin and soft tissue infections (SSTIs) frequently require management in the ICU, in part related to associated septic shock or toxic shock syndrome or associated organ failure. Four fundamental management principles are key to a successful outcome in caring for patients who have severe SSTIs, including (1) early diagnosis and differentiation of necrotizing versus nonnecrotizing SSTI, (2) early initiation of appropriate empiric broad-spectrum antimicrobial therapy with consideration of risk factors for specific pathogens and mandatory coverage for methicillin-resistant Staphylococcus aureus (MRSA), (3) source control (ie, early aggressive surgical intervention for drainage of abscesses and debridement of necrotizing soft tissue infections), and (4) pathogen identification and appropriate de-escalation of antimicrobial therapy. MRSA has emerged as the most common identifiable cause of severe SSTIs; therefore, initiation of empiric anti-MRSA antimicrobials is warranted in all cases of severe SSTIs. In addition, appropriate critical care management-including fluid resuscitation, organ support and nutritional support-is a necessary component in treating severe SSTIs.
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Affiliation(s)
- Lena M Napolitano
- Division of Acute Care Surgery, (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan Health System, Room 1C340A-UH, 1500 E. Medical Center Drive, SPC 5033, Ann Arbor, MI 48109-5033, USA.
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Autiero I, Costantini S, Colonna G. Modeling of the bacterial mechanism of methicillin-resistance by a systems biology approach. PLoS One 2009; 4:e6226. [PMID: 19593454 PMCID: PMC2707609 DOI: 10.1371/journal.pone.0006226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 06/15/2009] [Indexed: 02/06/2023] Open
Abstract
Background A microorganism is a complex biological system able to preserve its functional features against external perturbations and the ability of the living systems to oppose to these external perturbations is defined “robustness”. The antibiotic resistance, developed by different bacteria strains, is a clear example of robustness and of ability of the bacterial system to acquire a particular functional behaviour in response to environmental changes. In this work we have modeled the whole mechanism essential to the methicillin-resistance through a systems biology approach. The methicillin is a β-lactamic antibiotic that act by inhibiting the penicillin-binding proteins (PBPs). These PBPs are involved in the synthesis of peptidoglycans, essential mesh-like polymers that surround cellular enzymes and are crucial for the bacterium survival. Methodology The network of genes, mRNA, proteins and metabolites was created using CellDesigner program and the data of molecular interactions are stored in Systems Biology Markup Language (SBML). To simulate the dynamic behaviour of this biochemical network, the kinetic equations were associated with each reaction. Conclusions Our model simulates the mechanism of the inactivation of the PBP by methicillin, as well as the expression of PBP2a isoform, the regulation of the SCCmec elements (SCC: staphylococcal cassette chromosome) and the synthesis of peptidoglycan by PBP2a. The obtained results by our integrated approach show that the model describes correctly the whole phenomenon of the methicillin resistance and is able to respond to the external perturbations in the same way of the real cell. Therefore, this model can be useful to develop new therapeutic approaches for the methicillin control and to understand the general mechanism regarding the cellular resistance to some antibiotics.
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Affiliation(s)
- Ida Autiero
- CRISCEB (Interdepartmental Research Center for Computational and Biotechnological Sciences), Second University of Naples, Naples, Italy
| | - Susan Costantini
- CRISCEB (Interdepartmental Research Center for Computational and Biotechnological Sciences), Second University of Naples, Naples, Italy
- CROM (Oncology Research Centre of Mercogliano) “Fiorentino Lo Vuolo”, Mercogliano, Italy
- Department of Biochemistry and Biophysics, Second University of Naples, Naples, Italy
- * E-mail:
| | - Giovanni Colonna
- CRISCEB (Interdepartmental Research Center for Computational and Biotechnological Sciences), Second University of Naples, Naples, Italy
- Department of Biochemistry and Biophysics, Second University of Naples, Naples, Italy
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US Hospitalizations and Costs for Illicit Drug Users with Soft Tissue Infections. J Behav Health Serv Res 2009; 37:508-18. [DOI: 10.1007/s11414-009-9177-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 03/15/2009] [Indexed: 11/27/2022]
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Invasive infections with community-associated methicillin-resistant Staphylococcus aureus after kidney transplantation. J Clin Microbiol 2008; 46:2809-13. [PMID: 18524959 DOI: 10.1128/jcm.00494-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report two cases of invasive infections caused by Panton-Valentine leukocidin-positive, community-associated, methicillin-resistant Staphylococcus aureus (CA-MRSA) after kidney transplantation. This report emphasizes the clinical importance of considering CA-MRSA as a causative agent in the differential diagnosis of infections of the skin and soft tissues in organ transplant recipients.
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