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Article Excerpt
The emergence of antimicrobial resistance has increasingly impeded the management of a number of clinically important infections. Noteworthy examples include infections caused by penicillin-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), antibioticresistant Pseudomonas aeruginosa, vancomycin-resistant enterococci (VRE), and fluoroquinolone-resistant Clostridium difficile.
Infections caused by MRSA, for instance, are occurring more frequently--in the community as well as in the hospital setting. Compared with infections caused by methicillin-susceptible S aureus (MSSA), MRSA infections are associated with longer hospital stays, higher mortality rates, and increased costs. (1-3) Similar adverse consequences have been observed in patients with other antimicrobial-resistant infections.
This Clinical Update sums up the findings of several recent studies on MRSA and other antibiotic-resistant pathogens and discusses the antibiotic options.
RECENT STUDIES
CA-MRSA skin infections
According to a recent study, community-associated MRSA (CAMRSA) infection has emerged among the urban poor in Chicago. (4) It appears to have occurred in addition to (rather than instead of) MSSA infection.
Hota and associates (4) analyzed the risk factors for CA-MRSA skin and soft tissue infections (SSTIs) at a public hospital in Chicago. Of the 73 strains tested, 79% were type USA300 on pulsed-field gel electrophoresis. The incidence of CAMRSA SSTIs increased from 24 cases per 100,000 persons in 2000 to 164.2 cases per 100,000 in 2005 (relative risk, 6.84). The incidence of MSSA infections was stable during this period.
The risk factors for CA-MRSA infections included recent incarceration, African American ethnicity, and residence at certain public housing complexes. Overcrowding was not a risk factor. Older age was inversely associated with the risk of MRSA infections. The authors note that CA-MRSA may become endemic as it disseminates within communities.
CA-MRSA pneumonia
A report from the CDC emphasizes the importance of being on the alert for CA-MRSA pneumonia, particularly during the influenza season. (5) This type of pneumonia often occurs in young, previously healthy persons, and it can be quickly fatal.
In December 2006 and January 2007, 10 cases of severe CA-MRSA pneumonia occurred in Louisiana and Georgia. These cases involved previously healthy persons, 5 of whom were younger than 15 years. MRSA was documented by specimens (usually sputum or blood) that were obtained from the patients less than 48 hours after hospitalization or arrival at the emergency department (ED). Its association with influenza was established by either laboratory testing or a...
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