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Carroll JJ. Xylazine-Associated Wounds and Related Health Concerns Among People Who Use Drugs: Reports From Front-Line Health Workers in 7 US States. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:222-231. [PMID: 38258791 DOI: 10.1177/29767342231214472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Xylazine, an adrenergic alpha-2 agonist increasingly present in the US drug supply, is associated with severe skin ulcers and other harms. Expert knowledge from front-line harm reduction and healthcare professionals is an essential component of evidence-based practice. The purpose of this study is to describe the progression and treatment of xylazine-associated wounds, other xylazine-related health concerns, and the most urgent research priorities as reported by front-line harm reduction and healthcare professionals serving people who use drugs. METHODS A convenience sample of 17 healthcare and harm reduction professionals who serve people who use drugs in the US states of Maryland, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, and Texas participated in semi-structured interviews. Participants were asked about the appearance and progression of xylazine-associated wounds; preferred treatment strategies; other xylazine-related harms experienced by people who use drugs; and the most urgent priorities for xylazine-related research. FINDINGS Xylazine-associated wounds were broadly described as small lesions appearing mostly on extremities both at and away from injection sites, often within hours or days of exposure, that quickly developed into large, complex, chronic wounds. Reported risk of secondary infection was generally low but appeared more common among unhoused populations. Most participants preferred conservative treatment strategies that included regular wound care, enzymatic debridement, and hygiene. Xylazine-associated wounds and xylazine withdrawal reportedly act as significant barriers to care, including addiction treatment. Participants reported urgent need for scientific research and evidence-based guidance on the management of xylazine-associated wounds and withdrawal. CONCLUSIONS High-quality scientific evidence on risk factors for xylazine-associated wounds and on their biologic mechanisms is needed. Such studies could inform new strategies for the prevention and treatment of these wounds. Efforts to improve the management of xylazine withdrawal and to reduce stigma by incorporating harm reduction professionals into healthcare settings may improve access to and retention in care.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology and Anthropology, NC State University, Raleigh, NC, USA
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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2
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Bălăceanu-Gurău B, Apostol E, Caraivan M, Ion A, Tatar R, Mihai MM, Popa LG, Gurău CD, Orzan OA. Cutaneous Adverse Reactions Associated with Tattoos and Permanent Makeup Pigments. J Clin Med 2024; 13:503. [PMID: 38256637 PMCID: PMC10816451 DOI: 10.3390/jcm13020503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Tattooing is the procedure of implanting permanent pigment granules and additives into the dermal layer of the skin, serving various purposes such as decoration, medical identification, or accidental markings. There has been a significant rise in the popularity of decorative tattooing as a form of body art among both teenagers and young adults. Thus, the incidence of tattoos is increasing, with expanding applications such as permanent makeup, scar camouflage, nipple-areola, lips, and eyebrows tattooing, and utilization in oncological radiotherapy such as colon marking. However, there have been reported a broad range of adverse reactions linked to tattooing, encompassing allergic reactions, superficial and deep cutaneous infections, autoimmune disorders induced by the Koebner phenomenon, cutaneous tumors, and others. These reactions exhibit different onset times for symptoms, ranging from immediate manifestations after tattoo application to symptoms emerging several years later. Given the limited information on a tattoo's side effects, this review aims to elucidate the clinical spectrum of cutaneous complications of tattoos in different patients. The analysis will investigate both allergic and nonallergic clinical presentations of tattoo-related side effects, microscopic findings from skin biopsies, and therapeutic outcomes. This exploration is essential to improve our understanding of tattoo-related cutaneous complications and associated differential diagnoses and highlight the significance of patient awareness regarding potential risks before getting a tattoo.
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Affiliation(s)
- Beatrice Bălăceanu-Gurău
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Eliza Apostol
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | | | - Ana Ion
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Raluca Tatar
- Department of Plastic Reconstructive Surgery and Burns, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Plastic Reconstructive Surgery and Burns, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 010621 Bucharest, Romania
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristian-Dorin Gurău
- Orthopedics and Traumatology Clinic, Clinical Emergency Hospital, 014451 Bucharest, Romania;
| | - Olguța Anca Orzan
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.B.-G.); (E.A.); (A.I.); (M.M.M.); (L.G.P.); (O.A.O.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
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3
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Zhang J, Conly J, McClure J, Wu K, Petri B, Barber D, Elsayed S, Armstrong G, Zhang K. A Murine Skin Infection Model Capable of Differentiating the Dermatopathology of Community-Associated MRSA Strain USA300 from Other MRSA Strains. Microorganisms 2021; 9:microorganisms9020287. [PMID: 33573328 PMCID: PMC7912111 DOI: 10.3390/microorganisms9020287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/31/2022] Open
Abstract
USA300 is a predominant and highly virulent community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain that is a leading cause of skin and soft tissue infections. We established a murine intradermal infection model capable of demonstrating dermatopathological differences between USA300 and other MRSA strains. In this model, USA300 induced dermonecrosis, uniformly presenting as extensive open lesions with a histologically documented profound inflammatory cell infiltrate extending below the subcutis. In contrast, USA400 and a colonizing control strain M92 caused only localized non-ulcerated skin infections associated with a mild focal inflammatory infiltrate. It was also determined that the dermonecrosis induced by USA300 was associated with significantly increased neutrophil recruitment, inhibition of an antibacterial response, and increased production of cytokines/chemokines associated with disease severity. These results suggest that induction of severe skin lesions by USA300 is related to over-activation of neutrophils, inhibition of host antibacterial responses, and selective alteration of host cytokine/chemokine profiles.
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Affiliation(s)
- Jack Zhang
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
| | - John Conly
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- Department of Medicine, University of Calgary, Calgary, AB T2N4N1, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services, Alberta Precision Laboratories, University of Calgary, Calgary, AB T2N4N1, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1, Canada
| | - JoAnn McClure
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Centre for Antimicrobial Resistance, Alberta Health Services, Alberta Precision Laboratories, University of Calgary, Calgary, AB T2N4N1, Canada
| | - Kaiyu Wu
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
| | - Bjӧrn Petri
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1, Canada
| | - Duane Barber
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
| | - Sameer Elsayed
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- Department of Medicine, University of Western Ontario, London, ON N6A5C1, Canada
| | - Glen Armstrong
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
| | - Kunyan Zhang
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB T2N4N1, Canada; (J.Z.); (J.C.); (J.M.); (K.W.); (D.B.)
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB T2N4N1, Canada; (B.P.); (S.E.); (G.A.)
- Department of Medicine, University of Calgary, Calgary, AB T2N4N1, Canada
- Centre for Antimicrobial Resistance, Alberta Health Services, Alberta Precision Laboratories, University of Calgary, Calgary, AB T2N4N1, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1, Canada
- Correspondence: ; Tel.: +1-403-210-8484
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Merrill DR, Long B. Arthropod Assault: A Case Report of Brown Recluse Envenomation in a Training Environment. Mil Med 2020; 185:e1880-e1881. [PMID: 32459838 DOI: 10.1093/milmed/usaa092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/12/2022] Open
Abstract
Spider bites are a common emergency department complaint, accounting for ~21% of noncanine bites, injuries, and stings. Military service members, more so than most civilian personnel, are exposed to conditions that place them at increased risk for envenomation, stings, and bites. We present the case of an active duty service member working in a relatively austere environment who presented to a level 1 trauma center with a lesion consistent with a bite from a brown recluse spider, or Loxosceles reclusa.
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Affiliation(s)
- Daniel R Merrill
- San Antonio Uniformed Health Education Consortium, 3551 Roger Brooke Dr., San Antonio, TX 78234, USA
| | - Brit Long
- San Antonio Uniformed Health Education Consortium, 3551 Roger Brooke Dr., San Antonio, TX 78234, USA
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5
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Ness RA, Bennett JG, Elliott WV, Gillion AR, Pattanaik DN. Impact of β-Lactam Allergies on Antimicrobial Selection in an Outpatient Setting. South Med J 2019; 112:591-597. [PMID: 31682741 DOI: 10.14423/smj.0000000000001037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine whether patients prescribed nonpreferred antibiotics received appropriate alternative antibiotics. METHODS This was a retrospective observational analysis of military veteran patients with a β-lactam allergy treated in an outpatient clinic or emergency department for an infection during a 5-year span. Antibiotic regimens were first stratified as preferred or nonpreferred based on infection-specific guidelines. The nonpreferred regimens were then evaluated for appropriateness based on allergy history and culture and sensitivity reports. RESULTS Of 445 fills of antibiotics evaluated, 269 met inclusion criteria, comprising 253 unique infections in 80 patients. Patients received nonpreferred antibiotics for their infection type in 57% of cases. Of the nonpreferred antibiotics, 56% were inappropriate based on guideline-recommended alternatives, allergy history, and culture and sensitivity data. Of the 88 allergies, 97% were historical/self-reported and 48% were cutaneous. In addition, 39% of patients safely received β-lactam antibiotics after documentation of their allergy. CONCLUSIONS Patients with documented β-lactam allergies are at high risk of receiving nonpreferred and inappropriate antibiotics, and many reactions likely do not reflect true allergies. These data emphasize the negative impact of the "β-lactam allergy" label and the importance of reassessing allergies.
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Affiliation(s)
- Rachel A Ness
- From the Departments of Pharmacy and Allergy and Immunology, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Jessica G Bennett
- From the Departments of Pharmacy and Allergy and Immunology, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Whitney V Elliott
- From the Departments of Pharmacy and Allergy and Immunology, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Amanda R Gillion
- From the Departments of Pharmacy and Allergy and Immunology, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Debendra N Pattanaik
- From the Departments of Pharmacy and Allergy and Immunology, Veterans Affairs Medical Center, Memphis, Tennessee
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Abstract
Doxycycline, a member of the tetracycline family, is a drug used as an antibiotic (dosage of 100 mg/day) and as an anti-inflammatory drug on the dosage of 20 mg twice a day, this use has Matrix Metalloproteinases (MMP) inhibitor action. Doxycycline is a calcium chelator and therefore interferes in bone remodeling. The main objective of this study was to evaluate the action of the drug doxycycline in the control of osteopenia. Sixty three Wistars rats were divided into 9 groups with n = 7 each, as follow: the control group with doxycycline 10 mg/kg/day (C10), control with doxycycline 30 mg/kg/day (C30) and control (C), ovariectomized group with doxycycline 10 mg/kg/day (OVX10), ovariectomized with doxycycline 30 mg/kg/day (OVX30), and ovariectomized with water (OVX), sedentary group with 10 mg/kg/day (Se10), sedentary with doxycycline 30 mg/kg/day (Se30), and sedentary group with water (Se). Left femoral bone was used for bone densitometry, right femoral bone for histological analysis. The right tibia was intended for chemical quantifications, the total serum was used for cholesterol and calcium quantification. The length of the left femoral bone was measured after the densitometry analysis. Statistical analysis was performed using multivariate general linear model (ANOVA two factors with Bonferroni adjustment) and the TRAP analysis was subjected to normality test and then were subjected to nonparametric test, both with p < 0.05 significance. Statistically significant differences were found, with better results for the groups exposed to the medication (10 and 30 mg/kg/day): Se vs. Se10 and Se vs. Se30 for BMC, quantification of magnesium, amount of cancellous bone in the distal portion; OVX vs. OVX10 for BMC, BMD and calcium in serum; OVX vs. OVX10 and OVX30 for quantification in proximal and distal portion of cancellous bone; Se vs. Se30 and OVX vs. OVX30 for immunostaining for TRAP, all results with minimum of p ≤ 0.05. Doxycycline had a deleterious effect on control groups and positive action for bone organization on female rats affected by bilateral ovariectomy-induced osteopenia and sedentary lifestyle.
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7
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Dalman M, Bhatta S, Nagajothi N, Thapaliya D, Olson H, Naimi HM, Smith TC. Characterizing the molecular epidemiology of Staphylococcus aureus across and within fitness facility types. BMC Infect Dis 2019; 19:69. [PMID: 30658587 PMCID: PMC6339305 DOI: 10.1186/s12879-019-3699-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a common bacterium found in the nose and throat of healthy individuals, and presents risk factors for infection and death. We investigated environmental contamination of fitness facilities with S. aureus in order to determine molecular types and antibiotic susceptibility profiles of contaminates that may be transmitted to facility patrons. METHODS Environmental swabs (n = 288) were obtained from several fitness facilities (n = 16) across Northeast Ohio including cross-fit type facilities (n = 4), traditional iron gyms (n = 4), community center-based facilities (n = 5), and hospital-associated facilities (n = 3). Samples were taken from 18 different surfaces at each facility and were processed within 24 h using typical bacteriological methods. Positive isolates were subjected to antibiotic susceptibility testing and molecular characterization (PVL and mecA PCR, and spa typing). RESULTS The overall prevalence of S. aureus on environmental surfaces in the fitness facilities was 38.2% (110/288). The most commonly colonized surfaces were the weight ball (62.5%), cable driven curl bar, and CrossFit box (62.5%), as well as the weight plates (56.3%) and treadmill handle (50%). Interestingly, the bathroom levers and door handles were the least contaminated surfaces in both male and female restroom facilities (18.8%). Community gyms (40.0%) had the highest contamination prevalence among sampled surfaces with CrossFit (38.9%), traditional gyms (38.9%), and hospital associated (33.3%) contaminated less frequently, though the differences were not significant (p = 0.875). The top spa types found overall were t008 (12.7%), t267 (10.0%), t160, t282, t338 (all at 5.5%), t012 and t442 (4.5%), and t002 (3.6%). t008 and t002 was found in all fitness facility types accept Crossfit, with t267 (25%), t548, t377, t189 (all 10.7%) the top spa types found within crossfit. All samples were resistant to benzylpenicillin, with community centers having significantly more strains resistant to oxacillin (52.8%), erythromycin (47%), clindamycin (36%), and ciprofloxacin (19%). Overall, 36.3% of isolates were multidrug resistant. CONCLUSIONS Our pilot study indicates that all facility types were contaminated by S. aureus and MRSA, and that additional studies are needed to characterize the microbiome structure of surfaces at different fitness facility types and the patrons at these facilities.
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Affiliation(s)
- Mark Dalman
- Kent State University, College of Podiatric Medicine, 6000 Rockside Woods Blvd. N, Independence, OH 44131 USA
| | - Sabana Bhatta
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, Kent State University, College of Public Health, Kent, OH USA
| | - Nagashreyaa Nagajothi
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, Kent State University, College of Public Health, Kent, OH USA
| | - Dipendra Thapaliya
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, Kent State University, College of Public Health, Kent, OH USA
| | - Hailee Olson
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, Kent State University, College of Public Health, Kent, OH USA
| | - Haji Mohammad Naimi
- Department of Microbiology, Kabul University, Faculty of Pharmacy, Jamal Meena street, Kabul, Afghanistan
| | - Tara C. Smith
- Department of Biostatistics, Environmental Health Sciences and Epidemiology, Kent State University, College of Public Health, Kent, OH USA
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Mischlinger J, Lagler H, Harrison N, Ramharter M. Dalbavancin for outpatient parenteral antimicrobial therapy of skin and soft tissue infections in a returning traveller : Proposal for novel treatment indications. Wien Klin Wochenschr 2017; 129:642-645. [PMID: 28776100 DOI: 10.1007/s00508-017-1243-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
Skin and soft tissue infections (SSTIs) are among the most common health problems in travellers returning from tropical and subtropical countries. Importantly, the prevalence of Staphylococcus aureus, the most common pathogen for purulent SSTIs, with specific drug resistance, such as methicillin resistant Staphylococcus aureus (MRSA) and those expressing virulence genes, such as Panton-Valentine-leukocidin is higher in tropical regions than in most high resource settings. This poses challenges for the empirical antimicrobial treatment of SSTIs in returning travellers. This short report describes a patient with a recent travel history to Hong Kong, Singapore and the Philippines who presented with multiple mosquito bites on both upper extremities and secondary bacterial superinfection. He had previously been prescribed oral beta-lactam antimicrobial therapy but lacked adherence to this treatment. Based on the risk for MRSA infection and problems with treatment adherence to oral therapy an outpatient parenteral antimicrobial therapy with dalbavancin was administered on days 0 and 7. Microbiological culture confirmed presence of MRSA and clinical follow-up demonstrated complete remission of the SSTI within 2 weeks. Dalbavancin is a promising treatment option for empirical parenteral treatment of SSTIs in returning travellers, a population at high risk for beta-lactam resistant S. aureus skin infections.
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Affiliation(s)
- Johannes Mischlinger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria. .,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
| | - Heimo Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicole Harrison
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
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9
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Antibiotic tolerance and the alternative lifestyles of Staphylococcus aureus. Essays Biochem 2017; 61:71-79. [PMID: 28258231 DOI: 10.1042/ebc20160061] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 12/11/2022]
Abstract
Staphylococcus aureus has an incredible ability to survive, either by adapting to environmental conditions or defending against exogenous stress. Although there are certainly important genetic traits, in part this ability is provided by the breadth of modes of growth S. aureus can adopt. It has been proposed that while within their host, S. aureus survives host-generated and therapeutic antimicrobial stress via alternative lifestyles: a persister sub-population, through biofilm growth on host tissue or by growing as small colony variants (SCVs). Key to an understanding of chronic and relapsing S. aureus infections is determining the molecular basis for its switch to these quasi-dormant lifestyles. In a multicellular biofilm, the metabolically quiescent bacterial community additionally produces a highly protective extracellular polymeric substance (EPS). Furthermore, there are bacteria within a biofilm community that have an altered physiology potentially equivalent to persister cells. Recent studies have directly linked the cellular ATP production by persister cells as their key feature and the basis for their tolerance of a range of antibiotics. In clinical settings, SCVs of S. aureus have been observed for many years; when cultured, these cells form non-pigmented colonies and are approximately ten times smaller than their counterparts. Various genotypic factors have been identified in attempts to characterize S. aureus SCVs and different environmental stresses have been implicated as important inducers.
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10
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Lu C, Guo Y, Wang S, Wang Z, Chen L, Lv J, Qi X, Chen Z, Han L, Zhang X, Wang L, Yu F. Decreased Vancomycin MICs among Methicillin-Resistant Staphylococcus aureus Clinical Isolates at a Chinese Tertiary Hospital over a 12-year Period. Front Microbiol 2016; 7:1714. [PMID: 27833602 PMCID: PMC5081392 DOI: 10.3389/fmicb.2016.01714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/13/2016] [Indexed: 11/13/2022] Open
Abstract
The increased vancomycin minimum inhibitory concentration values (MICs) for methicillin-resistant Staphylococcus aureus (MRSA) isolates are associated with treatment failure and mortality of MRSA infections. In the present study, 553 non-duplicate MRSA isolates from various specimens of patients with infections at a Chinese tertiary hospital from January 2003 to December 2014, were selected randomly for investigating the shift of vancomycin MICs determined by E-test method. The percentages of the MRSA isolates with vancomycin MICs of ≥2.0, 1.5, 1.0, and ≤0.75 mg/L were 16.3% (90/553), 38.5% (213/553), 35.6% (197/553), and 9.9% (55/553), respectively. The highest geometric mean MIC (GM MIC) value (1.648 mg/L) and the lowest GM MIC (0.960 mg/L) were found in the first year (2003) and the last year (2014) over the study period, with significant difference (p < 0.05). The GM MICs over the study period fluctuated by year, with the elevated values in 2005, 2011, and 2013 and the decreased values in other years relative to the respective former year. The vancomycin GM MIC (1.307 mg/L) for MRSA isolates from sputum was the highest relative to that for the MRSA isolates from other specimens. By contrast, the vancomycin GM MIC value (1.156 mg/L) for MRSA isolates from pus was the lowest, with similar value to that for the isolates from blood. The vancomycin GM MICs in period I (2003-2005), period II (2006-2008), period III (2009-2011), and period IV (2012-2014) were 1.501, 1.345, 1.177, and 1.139 mg/L, respectively, with the continuous decreased trend. Compared with period I, the vancomycin GM MIC for MRSA isolates in period IV was significantly lower (p < 0.01), with a 1.318- fold decrease. The percentages of the isolates with vancomycin MIC ≥2 mg/L in four periods were 25, 15.6, 15.2, and 12%, respectively, with a continuous decrease. While the percentages of the isolates with vancomycin MIC ≤0.75 mg/L in four periods increased from 1.7% in period I to 19.3% in period IV. Taken together, a decreased trend in vancomycin MICs for MRSA isolates from a Chinese tertiary teaching hospital has been found. This pnenomenon was mainly associated with a decrease in the proportion of the MRSA isolates with vancomycin MIC ≥2 mg/L and an increase in the proportion of the MRSA isolates with vancomycin MIC ≤0.75 mg/L.
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Affiliation(s)
- Chaohui Lu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Yinjuan Guo
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Shanshan Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Zhengzheng Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Lan Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Jinnan Lv
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Xiuqin Qi
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Zengqiang Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Lizhong Han
- Department of Clinical Microbiology, Ruijin Hospital of Shanghai Jiaotong University Shanghai, China
| | - Xueqing Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Liangxing Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Fangyou Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China
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Yu F, Liu Y, Lu C, Lv J, Qi X, Ding Y, Li D, Huang X, Hu L, Wang L. Dissemination of fusidic acid resistance among Staphylococcus aureus clinical isolates. BMC Microbiol 2015; 15:210. [PMID: 26463589 PMCID: PMC4604626 DOI: 10.1186/s12866-015-0552-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant trend towards increased fusidic acid (FA) resistance among Staphylococcus aureus with increased duration of use is of concern. The aim of the present study is to investigate the dissemination of fusidic acid resistance among Staphylococcus aureus clinical isolates. METHODS The susceptibility of S. aureus isolates to antimicrobial agents was determined by disc-diffusion method. The minimal inhibitory concertrations(MICs) of fusidic acid and vacomycin for fusidic acid-resisitant isolates were determined by ager dillution method. FA resistance determinants were determined by PCR and DNA sequencing. SCCmec typing, spa typing and multi-locus sequence typing were used for the determination of molecular characteristics for S. aureus isolates. RESULTS A total of 392 non-duplicate S. aureus isolates including 181 methicillin-resistant S. aureus (MRSA) isolates, which were isolated from the clinical specimens of patients at a Chinese tertiary hospital from January, 2012 to September, 2013, were collected for investigating FA resistance. Among 392 S. aureus clinical isolates tested, 56 (14.3%) with FA MIC values ranging from 2 μg/ml to ≥128 μg/ml were resistant to FA. The proportions of FA resistance among MRSA and MSSA isolates were 27.1% (49/181) and 3.3% (7/211). There was a trend of rapidly increased FA resistance among S. aureus and MRSA isolates from 5.2% and 8.9% in 2012 to 24.9% and 45.1% in 2013. Acquired FA resistance gene, fusB, was present in 73.2% (41/56) of FA-resistant S. aureus isolates. fusC and fusA mutation were not found in any of tested isolates. A total of 9 sequence types (STs) and 12 spa types were identified among the 56 FA-resistant S. aureus isolates. ST5 accounting for 66.1% (37/56) was the most prevalent ST. The majority (92.9%, 52/56) of the isolates tested belonged to clonal complex 5(CC5). t2460 was the most prevalent spa type, accounting for 67.9% (38/56) . ST5-MRSA- II-t2460 was predominant clone, accounting for 75.5% (37/49) of FA-resistant MRSA isolates and 66.1% (37/56) of FA-resistant S. aureus isolates. Five of 7 FA-resistant MSSA isolates belonged to ST630-MSSA. CONCLUSION Increased FA resistance among S. aureus isolates was found in China. fusB was predominant FA resistance determinant. The spread of CC5 clone, especially novel ST5-MRSA- II-t2460 clone with high-level resistance to FA, was responsible for the increase of FA resistance.
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Affiliation(s)
- Fangyou Yu
- Department of Laboratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Yunling Liu
- Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Chaohui Lu
- Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Jinnan Lv
- Department of Laboratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Xiuqin Qi
- Department of Laboratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Yu Ding
- Department of Laboratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Dan Li
- Department of Laboratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Xiaoying Huang
- Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Longhua Hu
- Department of Laboratory Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, 336000, China.
| | - Liangxing Wang
- Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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12
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Tay ET, Tsung JW. Sonographic appearance of angioedema in local allergic reactions to insect bites and stings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1705-1710. [PMID: 25154956 DOI: 10.7863/ultra.33.9.1705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Soft tissue infections and angioedema from insect bites and stings may be difficult to differentiate by inspection. We present sonographic findings of 4 cases of soft tissue swelling from insect bites and stings suggestive of angioedema. Sonographic features of soft tissue angioedema consist of thickened subcutaneous tissue layers with multiple linear, horizontal, striated, and hypoechoic lines following the tissue planes between soft tissue layers. In addition to the history and physical examination, sonographic findings may assist in differentiating between local allergic reactions and cellulitis in patients with insect bites and stings. Further study is warranted for clinical application.
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Affiliation(s)
- Ee Tein Tay
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York USA.
| | - James W Tsung
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York USA
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13
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Islam N, Kim Y, Ross JM, Marten MR. Proteomic analysis of Staphylococcus aureus biofilm cells grown under physiologically relevant fluid shear stress conditions. Proteome Sci 2014; 12:21. [PMID: 24855455 PMCID: PMC4013085 DOI: 10.1186/1477-5956-12-21] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/17/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The biofilm forming bacterium Staphylococcus aureus is responsible for maladies ranging from severe skin infection to major diseases such as bacteremia, endocarditis and osteomyelitis. A flow displacement system was used to grow S. aureus biofilms in four physiologically relevant fluid shear rates (50, 100, 500 and 1000 s(-1)) to identify proteins that are associated with biofilm. RESULTS Global protein expressions from the membrane and cytosolic fractions of S. aureus biofilm cells grown under the above shear rate conditions are reported. Sixteen proteins in the membrane-enriched fraction and eight proteins in the cytosolic fraction showed significantly altered expression (p < 0.05) under increasing fluid shear. These 24 proteins were identified using nano-LC-ESI-MS/MS. They were found to be associated with various metabolic functions such as glycolysis / TCA pathways, protein synthesis and stress tolerance. Increased fluid shear stress did not influence the expression of two important surface binding proteins: fibronectin-binding and collagen-binding proteins. CONCLUSIONS The reported data suggest that while the general metabolic function of the sessile bacteria is minimal under high fluid shear stress conditions, they seem to retain the binding capacity to initiate new infections.
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Affiliation(s)
- Nazrul Islam
- Current address: Department of Plant Sciences, University of Maryland, College Park, MD 20742, USA
| | - Yonghyun Kim
- Department of Chemical and Biological Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Julia M Ross
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County (UMBC), Baltimore, MD 21250, USA
| | - Mark R Marten
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County (UMBC), Baltimore, MD 21250, USA
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Larru B, Gerber JS. Cutaneous bacterial infections caused by Staphylococcus aureus and Streptococcus pyogenes in infants and children. Pediatr Clin North Am 2014; 61:457-78. [PMID: 24636656 DOI: 10.1016/j.pcl.2013.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute bacterial skin and skin structure infections (SSSIs) are among the most common bacterial infections in children. The medical burden of SSSIs, particularly abscesses, has increased nationwide since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. SSSIs represent a wide spectrum of disease severity. Prompt recognition, timely institution of appropriate therapy, and judicious antimicrobial use optimize patient outcomes. For abscesses, incision and drainage are paramount and might avoid the need for antibiotic treatment in uncomplicated cases. If indicated, empiric antimicrobial therapy should target Streptococcus pyogenes for nonpurulent SSSIs, such as uncomplicated cellulitis, and S aureus for purulent SSSIs such as abscesses.
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Affiliation(s)
- Beatriz Larru
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA
| | - Jeffrey S Gerber
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA.
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Pulido Pérez A, Baniandrés Rodríguez O, Ceballos Rodríguez M, Mendoza Cembranos M, Campos Domínguez M, Suárez Fernández R. Skin Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus: Clinical and Microbiological Characteristics of 11 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Durdu M, Ruocco V. Clinical and cytologic features of antibiotic-resistant acute paronychia. J Am Acad Dermatol 2014; 70:120-6.e1. [DOI: 10.1016/j.jaad.2013.09.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 10/25/2022]
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Pulido Pérez A, Baniandrés Rodríguez O, Ceballos Rodríguez MC, Mendoza Cembranos MD, Campos Domínguez M, Suárez Fernández R. Skin infections caused by community-acquired methicillin-resistant Staphylococcus aureus: clinical and microbiological characteristics of 11 cases. ACTAS DERMO-SIFILIOGRAFICAS 2013; 105:150-8. [PMID: 24182658 DOI: 10.1016/j.ad.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that causes skin and soft-tissue infections. OBJECTIVE To describe the clinical characteristics of skin infections caused by CA-MRSA and correlations with the available demographic and microbiological data. MATERIAL AND METHODS This was a descriptive study of patients with a microbiologically confirmed diagnosis of CA-MRSA infection treated in a dermatology department between June 2009 and December 2011. We recorded demographic details, the clinical characteristics of lesions, and the treatments used. RESULTS We studied 11 patients (5 men and 6 women); 91% were under 40 years of age and had no relevant past medical history. The most common presentation was a skin abscess (with or without cellulitis). In all such cases, marked tissue necrosis and little or no purulent exudate was observed when the abscess was drained. Fifty percent of these abscesses had been treated previously with β-lactam antibiotics, and in all cases the lesions resolved after surgical drainage, which was combined in 63% of cases with quinolones or cotrimoxazole. CONCLUSIONS Today, skin infections due to CA-MRSA affect healthy young athletes who have no contact with healthcare settings. The most common presentation is a skin abscess characterized by marked tissue necrosis and little or no purulent exudate. In cases with these characteristics in susceptible patients, the involvement of CA-MRSA as the causative agent should be suspected. The abscesses should be drained whenever possible and, if necessary, antibiotic treatment should be prescribed; empirical use of β-lactam antibiotics should be avoided.
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Affiliation(s)
- A Pulido Pérez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - O Baniandrés Rodríguez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M D Mendoza Cembranos
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Campos Domínguez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Suárez Fernández
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Murphy CR, Hudson LO, Spratt BG, Elkins K, Terpstra L, Gombosev A, Nguyen C, Hannah P, Alexander R, Enright MC, Huang SS. Predictors of hospitals with endemic community-associated methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2013; 34:581-7. [PMID: 23651888 DOI: 10.1086/670631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to identify hospital characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among inpatients. DESIGN Prospective cohort study. SETTING Orange County, California. PARTICIPANTS Thirty hospitals in a single county. METHODS We collected clinical MRSA isolates from inpatients in 30 of 31 hospitals in Orange County, California, from October 2008 through April 2010. We characterized isolates by spa typing to identify CA-MRSA strains. Using California's mandatory hospitalization data set, we identified hospital-level predictors of CA-MRSA isolation. RESULTS CA-MRSA strains represented 1,033 (46%) of 2,246 of MRSA isolates. By hospital, the median percentage of CA-MRSA isolates was 46% (range, 14%-81%). In multivariate models, CA-MRSA isolation was associated with smaller hospitals (odds ratio [OR], 0.97, or 3% decreased odds of CA-MRSA isolation per 1,000 annual admissions; P < .001, hospitals with more Medicaid-insured patients (OR, 1.2; P = .002), and hospitals with more patients with low comorbidity scores (OR, 1.3; P < .001). Results were similar when restricted to isolates from patients with hospital-onset infection. CONCLUSIONS Among 30 hospitals, CA-MRSA comprised nearly half of MRSA isolates. There was substantial variability in CA-MRSA penetration across hospitals, with more CA-MRSA in smaller hospitals with healthier but socially disadvantaged patient populations. Additional research is needed to determine whether infection control strategies can be successful in targeting CA-MRSA influx.
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Affiliation(s)
- Courtney R Murphy
- School of Social Ecology and Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California.
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20
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Juhas E, English JC. Tattoo-associated complications. J Pediatr Adolesc Gynecol 2013; 26:125-9. [PMID: 23287600 DOI: 10.1016/j.jpag.2012.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/25/2012] [Accepted: 08/07/2012] [Indexed: 01/07/2023]
Abstract
Tattoo rates in the United States have been rising in recent years, with an expected concomitant rise in tattoo-associated complications. Tattoo complications range from cutaneous localized and generalized inflammatory eruptions, to local bacterial or viral infections, and finally to infectious endocarditis and hepatitis. Many complications may be avoided with proper counseling prior to tattoo placement, especially in high risk individuals. It is important for physicians to be able to recognize and diagnose complications from tattoos to avoid morbidity and possible mortality.
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Affiliation(s)
- Elizabeth Juhas
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Epicutaneous model of community-acquired Staphylococcus aureus skin infections. Infect Immun 2013; 81:1306-15. [PMID: 23381997 DOI: 10.1128/iai.01304-12] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus is one of the most common etiological agents of community-acquired skin and soft tissue infection (SSTI). Although the majority of S. aureus community-acquired SSTIs are uncomplicated and self-clearing in nature, some percentage of these cases progress into life-threatening invasive infections. Current animal models of S. aureus SSTI suffer from two drawbacks: these models are a better representation of hospital-acquired SSTI than community-acquired SSTI, and they involve methods that are difficult to replicate. For these reasons, we sought to develop a murine model of community-acquired methicillin-resistant S. aureus SSTI (CA-MRSA SSTI) that can be consistently reproduced with a high degree of precision. We utilized this model to begin to characterize the host immune response to this type of infection. We infected mice via epicutaneous challenge of the skin on the outer ear pinna using Morrow-Brown allergy test needles coated in S. aureus USA300. When mice were challenged in this model, they developed small, purulent, self-clearing lesions with predictable areas of inflammation that mimicked a human infection. CFU in the ear pinna peaked at day 7 before dropping by day 14. The T(h)1 and T(h)17 cytokines gamma interferon (IFN-γ), interleukin-12 (IL-12) p70, tumor necrosis factor alpha (TNF-α), IL-17A, IL-6, and IL-21 were all significantly increased in the draining lymph node of infected mice, and there was neutrophil recruitment to the infection site. In vivo neutrophil depletion demonstrated that neutrophils play a protective role in preventing bacterial dissemination and fatal invasive infection.
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Yu F, Li T, Huang X, Xie J, Xu Y, Tu J, Qin Z, Parsons C, Wang J, Hu L, Wang L. Virulence gene profiling and molecular characterization of hospital-acquired Staphylococcus aureus isolates associated with bloodstream infection. Diagn Microbiol Infect Dis 2012; 74:363-8. [PMID: 23021064 DOI: 10.1016/j.diagmicrobio.2012.08.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/16/2012] [Accepted: 08/18/2012] [Indexed: 11/28/2022]
Abstract
A better understanding of virulence gene profiling and molecular characterization of Staphylococcus aureus isolates associated with bloodstream infection (BSI) may provide further insights related to clinical outcomes with these infections. We analyzed 89 S. aureus isolates including 37 MRSA isolates (41.6%) recovered from 89 adult patients with BSI from 4 hospitals in Zhejiang province, eastern China. Thirty-five (94.6%) of MRSA isolates and 4 (7.7%) of methicillin-sensitive S. aureus (MSSA) isolates were resistant to multiple antimicrobials. All isolates harbored at least 2 of 22 possible virulence genes, including sdrC (92.1%), icaA (89.9%), hla (80.9%), clf (69.7%), sea (68.5%), sdrD (67.4%), hlb (67.4%), sdrE (65.2%), sei (51.7%), seg (50.6%), and cna (50.6%). Forty-four (49.4%) of all S. aureus BSI isolates, including 23 (62.2%) of MRSA isolates, harbored ≥10 of the virulence genes evaluated in this study. Sixteen (43.2%) MRSA isolates and 5 (9.6%) MSSA isolates harbored the gene encoding Panton-Valentine leukocidin (PVL). Collective genes for pvl, sdrE, sed, seg, and sei among MRSA isolates were significantly more frequent relative to MSSA isolates (P < 0.05). A total of 22 sequence types (STs), including novel ST2184, ST2199, and ST2200, and 33 spa types, including novel spa types t9530 and t9532, were identified among S. aureus BSI isolates, among which ST188 (15.7%) and ST7 (15.7%), and t091 (12.4%) and t189 (12.4%), seldom noted for Chinese isolates previously, were major STs and spa types, respectively. In contrast to previous reports, no predominant clones were found in the present study. Among the MRSA isolates, although ST239-MRSA-SCCmecIII, predominant clone in China, still represented the most common clone, it only accounted for 18.9%. However, ST188-MRSA- SCCmecIV seldom reported before accounted for 10.8%. Among the MSSA isolates, ST7-MSSA represented the most common clone (23.1%), followed by ST188-MSSA and ST630-MSSA (9.6% each). In conclusion, simultaneous carriage of multiple virulence genes and genetically considerable diversity were common among S. aureus BSI isolates. Furthermore, MRSA isolates exhibited more frequent carriage of superantigen genes and pvl relative to MSSA isolates. Taken together, there are distinctive virulence gene profiling and molecular characteristic among S. aureus isolates associated with bloodstream infection in China.
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Affiliation(s)
- Fangyou Yu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China
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Abstract
There are numerous cutaneous disorders that affect the foot, but of these conditions skin infections have the most significant impact on overall patient morbidity and clinical outcome. Skin infections in foot and ankle patients are common, with often devastating consequences if left unrecognized and untreated in both surgical and nonsurgical cases. There is a diverse array of infectious dermatoses that afflict the foot and ankle patient including tinea pedis, onychomycosis, paronychia, pitted keratolysis, verruca, folliculitis, and erysipelas. Prompt diagnosis, treatment, and surveillance of these common infectious conditions are critical in managing these dermatoses that can potentially progress to form deep abscesses and osteomyelitis. Infections can be managed with a combination of ventilated shoewear and synthetic substances to keep the feet dry, topical and oral antimicrobial agents, and patient education regarding preventative hygiene measures. The purpose of this review is to aid foot and ankle surgeons and other physicians in the diagnosis and treatment of infectious dermatoses affecting the foot.
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Affiliation(s)
- Andrew R Hsu
- Rush University Medical Center, Orthopaedic Surgery, Chicago, IL 60612, USA.
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Du J, Chen C, Ding B, Tu J, Qin Z, Parsons C, Salgado C, Cai Q, Song Y, Bao Q, Zhang L, Pan J, Wang L, Yu F. Molecular characterization and antimicrobial susceptibility of nasal Staphylococcus aureus isolates from a Chinese medical college campus. PLoS One 2011; 6:e27328. [PMID: 22114670 PMCID: PMC3219665 DOI: 10.1371/journal.pone.0027328] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/13/2011] [Indexed: 11/19/2022] Open
Abstract
Staphylococcus aureus colonization and infection occur more commonly among persons living or working in crowded conditions, but characterization of S. aureus colonization within medical communities in China is lacking. A total of 144 (15.4%, 144/935) S. aureus isolates, including 28 (3.0%, 28/935) MRSA isolates, were recovered from the nares of 935 healthy human volunteers residing on a Chinese medical college campus. All S. aureus isolates were susceptible to vancomycin, quinupristin/dalfopristin and linezolid but the majority were resistant to penicillin (96.5%), ampicillin/sulbactam (83.3%) and trimethoprim/sulfamethoxazole (93.1%). 82%, (23/28) of the MRSA isolates and 66% (77/116) of the MSSA isolates were resistant to multiple antibiotics, and 3 MRSA isolates were resistant to mupirocin—an agent commonly used for nasal decolonization. 16 different sequence types (STs), as well as SCCmec genes II, III, IVd, and V, were represented among MRSA isolates. We also identified, for the first time, two novel STs (ST1778 and ST1779) and 5 novel spa types for MRSA. MRSA isolates were distributed in different sporadic clones, and ST59-MRSA-VId- t437 was found within 3 MRSA isolates. Moreover, one isolate with multidrug resistance belonging to ST398-MRSA-V- t571 associated with animal infections was identified, and 3 isolates distributed in three different clones harbored PVL genes. Collectively, these data indicate a high prevalence of nasal MRSA carriage and molecular heterogeneity of S. aureus isolates among persons residing on a Chinese medical college campus. Identification of epidemic MRSA clones associated with community infection supports the need for more effective infection control measures to reduce nasal carriage and prevent dissemination of MRSA to hospitalized patients and health care workers in this community.
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Affiliation(s)
- Jimei Du
- School of Laboratory Medicine, Wenzhou Medical College, Wenzhou, China
| | - Chun Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Baixing Ding
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Jinjing Tu
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Zhiqiang Qin
- Division of Infectious Diseases, Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Chris Parsons
- Division of Infectious Diseases, Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Cassandra Salgado
- Division of Infectious Diseases, Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Qiangjun Cai
- School of Laboratory Medicine, Wenzhou Medical College, Wenzhou, China
| | - Yulong Song
- School of Laboratory Medicine, Wenzhou Medical College, Wenzhou, China
| | - Qiyu Bao
- School of Laboratory Medicine, Wenzhou Medical College, Wenzhou, China
| | - Liming Zhang
- Department of Clinical Laboratory, Taizhou Center Hospital, Taizhou, China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Liangxing Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
- * E-mail: (LW); (FY)
| | - Fangyou Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
- * E-mail: (LW); (FY)
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Tlougan BE, Mancini AJ, Mandell JA, Cohen DE, Sanchez MR. Skin Conditions in Figure Skaters, Ice-Hockey Players and Speed Skaters. Sports Med 2011; 41:967-84. [DOI: 10.2165/11592190-000000000-00000] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Balma-Mena A, Lara-Corrales I, Zeller J, Richardson S, McGavin MJ, Weinstein M, Pope E. Colonization with community-acquired methicillin-resistant Staphylococcus aureus in children with atopic dermatitis: a cross-sectional study. Int J Dermatol 2011; 50:682-8. [PMID: 21595661 DOI: 10.1111/j.1365-4632.2010.04751.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bacterial infection with Staphylococcus aureus is a common complication of atopic dermatitis (AD). The incidence of community-acquired methicillin-resistant S. aureus infection (MRSA) in the AD population is unknown. OBJECTIVES This study aimed to assess the prevalence of S. aureus and MRSA in pediatric patients with AD, to compare disease severity, and to characterize the clonal diversity of the isolates. METHODS We carried out a prospective, cross-sectional study of 200 patients with AD. The severity of AD was defined as mild, moderate, or severe depending on a composite AD severity score. A swab was taken from the nares of each patient and another from affected skin or folds. Genotyping of all S. aureus isolates was conducted by polymerase chain reaction (PCR) amplification of the S. aureus protein A (spa) gene. RESULTS According to the severity score, 66.5% of subjects were ranked as having mild AD, 29.5% as having moderate and 4% as having severe AD. Staphylococcus aureus colonization was seen in 61.5% of all patients, represented by 43.7% of skin swabs and 48% of nares swabs. Only one of the isolations represented MRSA. Older age and higher AD severity scores were associated with S. aureus colonization (P = 0.03 and P < 0.001, respectively). No significant associations were noted for attendance at day care, family members with frequent skin infections, or family members working in healthcare. Isolates from spa CC015 were cultured in 19.2% of patient samples. The single MRSA culture showed a new spa type that belonged to CC127. CONCLUSIONS The results of this study confirm a high rate of S. aureus colonization of pediatric patients with AD. The low rate of MRSA requires further proof from larger prospective studies.
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Affiliation(s)
- Alexandra Balma-Mena
- Division of Pediatric Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
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Alder AC, Thornton J, McHard K, Buckins L, Barber R, Skinner MA. A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children. J Pediatr Surg 2011; 46:1942-7. [PMID: 22008332 DOI: 10.1016/j.jpedsurg.2011.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/25/2011] [Accepted: 05/30/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Soft tissue infections are increasingly being seen for surgical management, which is associated with painful dressing changes, lost days at school, time away from family, and scarring, which can have a great impact on both child and caretaker. We postulated that a drainage technique using a modified Pezzar catheter would be associated with shorter hospital stays and less wound care. METHODS A consecutive series of 400 children with soft tissue abscesses was evaluated from April 2007 to October 2008. Children were managed according to the operating surgeon's preference. Children remained in the hospital until they were afebrile and the wounds could be adequately managed at home. Drains were removed 1 week after surgery in clinic. RESULTS There were no treatment failures. Three hundred twenty-two children were managed with standard incision and drainage (I&D) and 78 patients with catheter drainage. Twenty-two children in the catheter drainage group (28%) required hospitalization of greater than 1 day compared with 151 children (47%) in the I&D group (P = .001, Fisher exact test). Thirty-four percent of the children managed with I&D required packing at home, which was required in none of the patients managed with catheter drainage. Patient age, catheter drainage, and site of the lesion were associated independently with shorter hospital stays. CONCLUSION We conclude that catheter drainage of soft tissue abscesses in children is safe and effective. Catheter drainage is associated with a decreased hospital stay. Other factors related to shorter hospital stays include age of the patient and the site of soft tissue abscess.
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Affiliation(s)
- Adam C Alder
- Department of Pediatric Surgery, Children's Medical Center, UT Southwestern, Dallas, TX, USA.
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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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Hansra NK, Shinkai K. Cutaneous community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus. Dermatol Ther 2011; 24:263-72. [PMID: 21410616 DOI: 10.1111/j.1529-8019.2011.01402.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The clinical presentation of methicillin-resistant Staphylococcus aureus (MRSA) infection ranges from asymptomatic colonization to cutaneous and invasive involvement. This review discusses the cutaneous presentations of community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA) that one may encounter in the hospital or outpatient setting. Cutaneous CA-MRSA and HA-MRSA are often clinically indistinguishable, although they have different epidemiologic profiles and virulence factors. Bacterial culture is necessary for diagnosis and guides treatment, as infection with CA-MRSA and HA-MRSA require distinct clinical management. Guidelines for surgical interventions and antibiotic treatment of CA-MRSA and HA-MRSA will be discussed. Strategies for MRSA decolonization and prevention of further spread will also be reviewed.
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Affiliation(s)
- Nina Kaur Hansra
- Department of Dermatology, University of California-San Francisco, 1701 Divisadero Street, San Francisco, CA 94143, USA
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Use of a Clinical Decision Support Tool to Improve Guideline Adherence for the Treatment of Methicillin-Resistant Staphylococcus aureus. Adv Emerg Nurs J 2011; 33:252-66. [DOI: 10.1097/tme.0b013e31822610d1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Desai R, Pannaraj PS, Agopian J, Sugar CA, Liu GY, Miller LG. Survival and transmission of community-associated methicillin-resistant Staphylococcus aureus from fomites. Am J Infect Control 2011; 39:219-25. [PMID: 21458684 DOI: 10.1016/j.ajic.2010.07.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 07/04/2010] [Accepted: 07/06/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transmission of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) from fomites appears to play an important role in CA-MRSA outbreaks. However, the amount and duration of transmissibility of MRSA have not been quantified. METHODS We assessed the survival and transmission of the CA-MRSA strain USA300-0114 from 9 fomites (razors, plastic toys, ceramic, soap, wood, vinyl, towels, bed sheets, and shoulder pads). Fomites were inoculated then briefly pressed onto sterile pigskin at 5 minutes; days 1, 2, 3, 7, and 10; and then weekly for 10 weeks. The experiment was repeated using 2 methicillin-susceptible S aureus (MSSA) and 3 health care-associated (HA) MRSA strains on select fomites. RESULT Bacteria could be transmitted to skin from all fomites except soap. Transmissibility decreased over time but more rapidly from porous (eg, towels) than nonporous (eg, vinyl) fomites (P = .0002), with some fomites showing transmissibility for more than 8 weeks after contamination. The CA-MRSA strain was transmissible longer than the HA-MRSA strains (P < .0001) and 1 MSSA strain. CONCLUSION CA-MRSA strains are transmissible from many fomites to skin with contaminated nonporous fomites exhibiting transmissibility many weeks after contamination. Transmissibility of HA-MRSA strains demonstrated attenuated transmissibility compared with CA-MRSA strains. Findings may have implications for CA-MRSA infection prevention.
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Affiliation(s)
- Rishi Desai
- Division of Pediatric Infectious Diseases, Childrens Hospital Los Angeles, CA, USA.
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Cataldo MA, Taglietti F, Petrosillo N. Methicillin-resistant Staphylococcus aureus: a community health threat. Postgrad Med 2011; 122:16-23. [PMID: 21084777 DOI: 10.3810/pgm.2010.11.2218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA), one of the most common causes of infections, has been traditionally recognized as a nosocomial pathogen. However, in recent years, its epidemiology has radically changed, being now observed even more frequently in the community, and accounting for > 50% of staphylococcal infections in the US outpatient setting. Community-acquired (CA)-MRSA strains typically cause infections among otherwise healthy individuals, with risk factors differing from those of nosocomial MRSA. The clinical manifestations may range from a furuncle to life-threatening infections, such as necrotizing fasciitis and pneumonia. The antibiotic treatment of these infections may also differ because CA-MRSA strains often retain susceptibility to antimicrobials other than glycopeptides and newer agents. Moreover, the production of toxins, such as the Panton-Valentine leukocidin (PVL), should influence the antibiotic choice because in these cases the use of a combination therapy with antimicrobial agents able to decrease toxin production is suggested. There are still many unanswered key questions regarding the epidemiology, prevention, and treatment of CA-MRSA infections. This article reviews current knowledge of CA-MRSA.
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Affiliation(s)
- Maria Adriana Cataldo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
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Berk DR, Bayliss SJ. MRSA, staphylococcal scalded skin syndrome, and other cutaneous bacterial emergencies. Pediatr Ann 2010; 39:627-33. [PMID: 20954609 DOI: 10.3928/00904481-20100922-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- David R Berk
- Department of Internal Medicine and Pediatrics, Division of Dermatology, Washington University School of Medicine and St. Louis Children's Hospital, MO, USA.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zervos M. Treatment Options for Uncomplicated Community-Acquired Skin and Soft Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus: Oral Antimicrobial Agents. Surg Infect (Larchmt) 2008; 9 Suppl 1:s29-34. [DOI: 10.1089/sur.2008.065.supp] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Marcus Zervos
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
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Yang LPH, Keam SJ. Retapamulin: a review of its use in the management of impetigo and other uncomplicated superficial skin infections. Drugs 2008; 68:855-73. [PMID: 18416589 DOI: 10.2165/00003495-200868060-00008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Topical retapamulin (Altabax, Altargo) is the first pleuromutilin antibacterial approved for the treatment of uncomplicated superficial skin infections caused by Staphylococcus aureus (excluding meticillin-resistant S. aureus [MRSA]) and Streptococcus pyogenes in patients aged > or = 9 months. In the EU, retapamulin is indicated for use in patients with impetigo or with infected small lacerations, abrasions or sutured wounds (without abscesses); in the US, it is indicated for use in patients with impetigo. Retapamulin has a novel site of action on bacterial ribosomes. In clinical trials in patients with impetigo, topical retapamulin 1% ointment twice daily for 5 days (the approved regimen) was superior to placebo; treatment with retapamulin was noninferior to that with topical fusidic acid. In patients with secondarily infected traumatic lesions, treatment with retapamulin was noninferior to that with oral cefalexin, although the efficacy of retapamulin was reduced in patients with MRSA infections or superficial abscesses. Retapamulin was well tolerated in both paediatric and adult patients, and the majority of adverse events were of mild to moderate severity. Thus, the introduction of topical retapamulin 1% ointment extends the treatment options available in the management of impetigo and uncomplicated secondarily infected traumatic lesions.
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Affiliation(s)
- Lily P H Yang
- Wolters Kluwer Health/Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand.
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Wu CT, Lin JJ, Hsia SH. Cutaneous pustular manifestations associated with disseminated septic embolism due to a Panton-Valentine leukocidin-producing strain of community-acquired methicillin-resistantStaphylococcus aureus. Int J Dermatol 2008; 47:942-3. [DOI: 10.1111/j.1365-4632.2008.03717.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Wallin TR, Hern HG, Frazee BW. Community-associated methicillin-resistant Staphylococcus aureus. Emerg Med Clin North Am 2008; 26:431-55, ix. [PMID: 18406982 DOI: 10.1016/j.emc.2008.01.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged over the last decade across the United States and the world, becoming a major pathogen in many types of community-acquired infections. Although most commonly associated with minor skin and soft tissue infections, such as furuncles, CA-MRSA also can cause necrotizing fasciitis, pyomyositis, osteoarticular infections, and community-acquired pneumonia. This article discusses the epidemiology, diagnosis, and management of these infections from the perspective of the emergency physician.
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Affiliation(s)
- Thomas R Wallin
- Department of Emergency Medicine, Alameda County Medical Center-Highland Campus, 1411 East 31st Street, Oakland, CA 94602, USA
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&NA;. Antibacterials are an essential component in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) skin infections. DRUGS & THERAPY PERSPECTIVES 2008. [DOI: 10.2165/00042310-200824070-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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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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