MRSA Infection

MRSA Staph Infections Grow in Metro

MyFox Kansas City | MRSA Staph Infections Grow in Metro.

That little spot turned into a mass of infection on the thigh, and then on his shin. The diagnosis was MRSA, a staph bacteria that's resistant to certain antibiotics that used to stop it. Although MRSA isn't getting a much attention as it did last fell, the number of people in the community who are becoming infected with MRSA has continued to steadily grow, according to Dr. Joel McKinsey. McKinsey is a specialist at Research Medical Center. He said cases are being diagnosed and treated sooner. But, there's also concern the enemy is getting more evasive and more resistant. "We have to be mindful of the fact that even antibiotics that we're used to treating MRSA with may become ineffecive over time," said Dr. McKinsey. There is some good news. New antibiotics are being tested to fight MRSA in both kids and adults. Current antibiotics worked for Brandon, but it wasn't easy. He was in the hospital for two days. Then, he needed an IV drip at home. He missed a month of work. And, he got married. But, he and his bride had to cancel their Caribbean honeymoon. He and Dr. McKinsey encourage others to keep an eye on cuts, nicks, or what you may think is just an ingrown hair. If it worsens, get medical help. "It might just save your life or save a limb," said Foster. He feels fortunate he only has scars from MRSA. Good handwashing is key to preventing MRSA. Also, don't share towels and other personal items. And, Dr. McKinsey says avoid using antibiotics when you have viral infections. That may help prevent more resistance.

Common staph germs getting stronger, more widespread

Common staph germs getting stronger, more widespread | ajc.com.

Now, the germs causing outbreaks in schools, on sports teams and in other social situations are posing a growing threat. A CDC study found that at least 10 percent of cases involving the most common community strain were able to evade the antibiotics typically used to treat them. “They’re becoming more resistant and they’re coming into the hospitals,” where they swap gene components with other bacteria and grow even more dangerous, said Dr. Keith Klugman, an infectious disease expert at Emory University. “It’s really a major epidemic.” The germ is methicillin-resistant Staphylococcus aureus, or MRSA. People can carry it on their skin or in their noses with no symptoms and still infect others - the reason many hospitals isolate and test new patients to see if they harbor the bug. MRSA mostly causes skin infections. Cleveland Browns tight end Kellen Winslow was just hospitalized for a staph infection, his second in recent years, and the team reportedly has had at least six cases in the past three years.

1 in 5 CA MRSA cases need hospital care

APUA: What is CA-MRSA.

Today, in the U.S. a little more than 10% of all MRSA infections are CA-MRSA. This form causes serious skin and soft tissue infections in otherwise healthy persons who have not been recently hospitalized or undergone invasive medical procedures. Hospitalization is required in approximately one out of five cases. CA-MRSA has been identified most frequently among specific populations, including prisoners, athletes, children, men who have sex with men, military recruits, Pacific Islanders, Alaskan Natives and Native Americans. A major difference between the two types of MRSA is that the community form (CA-MRSA) possesses a potent toxin called Panton-Valentine leukocidin, which attacks infection-fighting white blood cells called leukocytes. The most serious form of CA-MRSA infection causes necrotizing fasciitis, a severe, rapidly progressing and life-threatening skin infection. The CA-MRSA are genetically distinguishable from hospital associated MRSA. In the US, two clones (strains) of staph, called USA300 and USA400, are associated with the community MRSA (CA-MRSA). USA300 has emerged as the most prominent clone and is not found among hospital strains. It was not observed before the year 2000, when multiple other clones existed.

Kuwait has 2 CA MRSA Strains

Link: Genetic Lineages of Community-Associated Methicillin-Resistant Staphylococcus aureus in Kuwait Hospitals -- Udo et al. 46 (10): 3514 -- Journal of Clinical Microbiology.

Twenty-six community-associated methicillin-resistant Staphylococcus aureus (CAMSRA) isolates were characterized by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and screened for accessory gene regulator (agr), capsular polysaccharide (cap), and Panton-Valentine leucocidin (PVL) genes. They exhibited five PFGE patterns (types A to E). The majority were PFGE type A (12 isolates) or type B (8 isolates). MLST showed that PFGE type A isolates belonged to sequence type 80 (ST80), while the PFGE type B isolates were ST30. The ST80 and ST30 clones contained agr allotype 3, cap type 8, and PVL. The results showed that two internationally recognized CAMRSA clones are dominant in Kuwait hospitals.

Prisoners experience Chronic MRSA

Link: Predominance of Methicillin-Resistant Staphylococcus aureus among Pathogens Causing Skin and Soft Tissue Infections in a Large Urban Jail: Risk Factors and Recurrence Rates -- David et al. 46 (10): 3222 -- Journal of Clinical Microbiology.

In the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains emerged as pathogens outside of the health care environment. Epidemic foci of CA-MRSA infections were reported in jails and prisons, but risk factors for MRSA infection there are not known. All skin and soft tissue infections (SSTIs) cultured in the Cook County Jail in March 2004 to August 2005 were reviewed. Demographic and clinical risk factors were compared among patients with methicillin-susceptible S. aureus (MSSA) SSTIs and those with MRSA SSTIs. Antibiotic susceptibilities were recorded, and we performed multilocus sequence typing on a sample of MRSA isolates. There were 378 SSTIs from different patients requiring culture, of which 240 (63.5%) were of MRSA and 43 (11.4%) were of MSSA; 84.8% of S. aureus isolates were MRSA. MRSA- and MSSA-infected patients were similar with regard to age, gender, ethnicity, previous exposure to the jail, and comorbidities. In the 12 months prior to the index culture, MRSA patients were more likely to have received a β-lactam antibiotic (25% versus 9%; P = 0.02). Among 26 MRSA strains, 24 (92%) had the sequence type 8 (ST8) genotype. Within 6 months, 14% (95% confidence interval, 8.7% to 22.3%) of MRSA SSTI patients in the jail had a recurrent SSTI compared with 8.8% (95% confidence interval, 2.1% to 32.6%) of MSSA SSTI patients (P = 0.004). MRSA is the predominant cause of SSTIs requiring culture in the jail. Few risk factors differentiated MRSA from MSSA SSTIs, and detainee patients with MRSA SSTIs are at high risk for recurrent SSTIs.

CA MRSA in Greece

Link: Eurosurveillance - View Article.

A total of 959 individuals (874 males) aged 18 to 60 years (mean age 33) were enrolled in the study. Nine of the 959 participants (0.94%, 95% confidence interval [CI] 0.33% to 1.55%) were colonised with MRSA. All MRSA carriers were males. Two of the colonised individuals were smokers. One of the MRSA carriers reported systematic use of inhaled corticosteroids during the two months preceding enrolment. Another carrier had been treated with antibiotics two months prior to sampling. Three of the colonised individuals had been admitted to different hospitals at least once in the year before enrolment in the study. Two of them had been hospitalised in medical wards while the third one had been admitted to a surgical ward. In two MRSA carriers none of the investigated risk factors was identified. Among the demographic and clinical variables, prior hospitalisation and use of inhaled corticosteroids appeared to be correlated with an increased risk for MRSA colonisation (P<0.01) (Table 1).

Japanese concern over CA MRSA

Link: Molecular epidemiology and antimicrobial susceptibilities of 273 exfoliative toxin-encoding-gene-positive Staphylococcus aureus isolates from patients with impetigo in Japan -- Nakaminami et al. 57 (10): 1251 -- Journal of Medical Microbiology.

The molecular epidemiology and antimicrobial susceptibilities of 273 Staphylococcus aureus isolates positive for the exfoliative toxin-encoding gene obtained from patients with impetigo in Japan in 2006 were studied. The mecA gene was detected in 74 meticillin-resistant S. aureus (MRSA) and 23 meticillin-susceptible S. aureus (MSSA) isolates. All isolates with the staphylococcal cassette chromosome (SCC) mec were classified into type IV (92.8 %, 90/97) or V (7.2 %, 7/97). The ET-encoding gene etb was found primarily in strains with mecA (87.7 %, 71/81), whilst eta (86.6 %, 161/186) was detected mainly in strains without mecA. The chromosomal enterotoxin-encoding gene cluster egc was found in 83.0 % of strains with eta, whilst no enterotoxin-encoding gene was detected in strains with only etb. PFGE showed that each strain carrying eta, etb and etd could be classified into distinct groups. The susceptibility profiles of MRSA to antimicrobial agents excluding β-lactams were similar to those of MSSA. Gentamicin- and clarithromycin-resistant strains were frequently found for both MRSA and MSSA. The aminoglycoside-resistance gene aacA–aphD was detected in 97.3 % of MRSA and 85.4 % of MSSA. Additionally, the macrolide-resistance gene ermA or ermC was detected in 67.6 % of MRSA and 71.4 % of MSSA. Therefore, these results suggest that SCCmec types IV or V have spread, particularly in MSSA carrying etb in the community.

Not enough lab techs to keep track of CA MRSA

Link: BBC NEWS | Health | Fears voiced over new superbugs.

A leading microbiologist says he fears a major outbreak of new strains of community superbugs unless public monitoring is given more resources. Professor Hugh Pennington told the BBC the Health Protection Agency lacked the staff for the greater surveillance of such virulent and mutating bacteria. "If we do neglect these bugs, we neglect them at our peril," he said. The government's leading infection adviser said he was assured its monitors could cope with the workload. Concerns are growing among microbiologists about PVL (Panton-Valentine leukocidin), produced by some bacteria from the family Staphylococcus and which destroys white blood cells.

burns patients hard hit by MRSA

Link: HighWire Press -- Medline Abstract.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA), particularly USA300, is a major pathogen in the outpatient setting. We suspected that USA300 had been introduced into our burn-trauma unit (BTU) when three burn patients presented with numerous simultaneous abscesses. We did molecular typing on 206 MRSA isolates from all patients on the BTU who had MRSA isolated from either nares cultures or clinical specimens obtained between April 11, 2002 and October 24, 2006. We reviewed medical records for all patients who had USA300 and for 75 control patients. Twenty-five of 206 (12.1%) patients who were colonized (n = 3) or infected (n = 22) with MRSA had USA300. Thirteen patients had abscesses drained surgically and eight had necrotizing fasciitis excised. Seven patients had burns (mean burn size 11.8 +/- 3.4%), of who four (66.7%) acquired numerous simultaneous (3-33) abscesses. Fourteen patients acquired USA300 outside of the BTU, and three acquired this strain on the BTU. Cases were more likely to have been hospitalized or to have had an operation in the 6 months before they were hospitalized than were controls (P = .001 for both). To our knowledge, this is the first study to describe numerous simultaneous MRSA abscesses in burn patients. The MRSA strain USA300 may be introduced onto burn units from the community by patients admitted with skin and soft tissue infections, especially abscesses and necrotizing fasciitis. Burn patients may be at risk for numerous abscesses with USA300, because they have open wounds and their immune systems may be compromised.

CA MRSA to0 become the dominant infection?

Link: HighWire Press -- Medline Abstract.

Community-associated MRSA (CA-MRSA) strains have emerged in Uruguay. We reviewed Staphylococcus aureus isolates from a large healthcare facility in Montevideo (center A) and obtained information from 3 additional hospitals on patients infected with CA-MRSA. An infection was defined as healthcare-onset if the culture was obtained >48 hours after hospital admission. At center A, the proportion of S. aureus infections caused by CA-MRSA increased from 4% to 23% over 2 years; the proportion caused by healthcare-associated MRSA (HA-MRSA) decreased from 25% to 5%. Of 182 patients infected with CA-MRSA, 38 (21%) had healthcare-onset infections. Pulsed-field gel electrophoresis determined that 22 (92%) of 24 isolates were USA1100, a community strain. CA-MRSA has emerged in Uruguay and appears to have replaced HA-MRSA strains at 1 healthcare facility. In addition, CA-MRSA appears to cause healthcare-onset infections, a finding that emphasizes the need for infection control measures to prevent transmission within healthcare settings.

Treating CA MRSA

Link: HighWire Press -- Medline Abstract.

With the significant increase in the incidents of community-acquired methicillin-resistant S. aureus (CA-MRSA), it's important for ED managers to be conversant not only in hospital-acquired MRSA, but also this less lethal version. Here are some recommendations: The appropriate treatment for an abscess, the most common manifestation of CA-MRSA, is surgery. If an antibiotic is deemed necessary, the most effective against CA-MRSA is trimethoprim/ sulfamethoxazole. You may wish to culture all abscesses to determine the precise nature of the bacterium.

Possible MRSA Outbreak Probed At Water Park Under Construction

Link: MyFox Philadelphia | Possible MRSA Outbreak Probed At Water Park Under Construction.

The New Jersey Department of Health confirmed Wednesday that it's investigating a possible MRSA outbreak at a construction site in Mount Laurel. Workers claim at least five of them have been infected. They're working at an indoor water park on Route 73. A regional epidemiologist was at the site Wednesday to conduct some tests. The results haven't come back.

Antibiotic-resistant infections challenge Beaufort Memorial Hospital

Link: The Beaufort Gazette: Antibiotic-resistant infections challenge Beaufort Memorial Hospital.

"It seems to mostly be healthy, young people (who come in already infected). It's really throughout the county," said Bev Yoder, the hospital's infection control nurse. "We saw an increase about three to four months ago where it really seemed to be more than we expected to see." In 2007, there were about two or three cases per month. This year, it's up to three or four per month, primarily methicillin-resistant Staphylococcus aureus, or MRSA; vanocomycin-resistant Enterococci, or VRE; and Clostridium difficile. MRSA may show up as a boil that looks similar to a spider bite while the other infections often manifest as severe, debilitating diarrhea. The increase of incoming patients with bacterial infections might come from closer monitoring. In March, the hospital began using nasal swabs to test patients for infections who were admitted to the intensive care unit or were coming from a place other than home. Beaufort Memorial also can act much more quickly to treat the infections, thanks to a new $60,000 machine that can identify the bacterial infections almost immediately, compared to waiting a couple of days for cultures to ferment.

400% increase in MRSA among Children of Urban Poor

Link: UCSF Study Shows Sharp National Rise in Skin Infections, MRSA Suspected.

During that time period, office and emergency room visits for all skin infections rose from 8.6 million nationwide to 14.2 million, according to Adam Hersh, MD, PhD, lead author on the paper and a fellow in the divisions of general pediatrics and of pediatric infectious diseases at UCSF. The vast majority of that increase was attributable to visits for abscesses or cellulitis, which Hersh called the hallmark signs of infections from the variety of staph bacteria known as MRSA, or methicillin-resistant Staphylococcus aureus. Those infections rose from 4.6 million to 9.6 million during the study period. “This shows that community-acquired MRSA infections are occurring nationwide and affect all subsets of the population,” Hersh said. “But there clearly are some subsets that are disproportionately affected, such as children.“ The increase was predominantly seen among children and among patients who visit emergency rooms in urban areas at so-called safety net hospitals. Those are hospitals in which at least half of the patients receive Medicaid or are uninsured. From 1997 to 2005, the number of visits for abscesses or cellulitis nearly quadrupled in safety-net emergency departments, from 1.3 people per 1,000 total population to 4.9. Among children, the incidence nearly tripled from 10.1 patients per 1,000 children to 27.6. By contrast, incident rates among patients older than 45 rose less than 50 percent, from 27.9 to 41.3 patients per 1,000 adults in that age group.

CA MRSA still more treatable

Link: Associations between the Genotype of Staphylococcus aureus Bloodstream Isolates and the Clinical Characteristics and Outcomes of Bacteremic Patients -- Lalani et al., 10.1128/JCM.00905-08 -- Journal of Clinical Microbiology.

We investigated associations between the genotypic and phenotypic features of S. aureus bloodstream isolates and clinical characteristics of bacteremic patients enrolled in a Phase III trial of S. aureus bacteremia and endocarditis. Isolates underwent pulsed field gel electrophoresis, PCR for 33 putative virulence genes and screening for heteroresistant glycopeptide intermediate S. aureus (hGISA). Two hundred and thirty isolates (141 methicillin-susceptible S. aureus [MSSA], and 89 methicillin-resistant S. aureus [MRSA]) were analyzed. North American and European S. aureus isolates differed in their genotypic characteristics. Overall, 26% of the MRSA bloodstream isolates were USA 300. Patients with USA 300 MRSA bacteremia were more likely to be injection drug users (61% vs. 15%; p <0.001), to have right-sided endocarditis (39% vs. 9%; p=0.002), and to be cured of right-sided endocarditis (100% vs. 33%; p=0.01) than patients with non-USA 300 MRSA bacteremia. Patients with persistent bacteremia were less likely to be infected with Panton-Valentine leukocidin (pvl)-constitutive MRSA (19% vs. 56%; p=0.005). Although 7/89 MRSA isolates (8%) exhibited the hGISA phenotype, no association with persistent bacteremia, daptomycin resistance, or bacterial genotype was observed. This study suggests that the virulence gene profiles of S. aureus bloodstream isolates from North America and Europe differ significantly. In this study of bloodstream isolates collected as part of a multinational randomized clinical trial, USA 300 and pvl-constitutive MRSA were associated with better clinical outcomes.

CA MRSA Replacing HA MRSA as Threat to Cystic Fibrosis Children

Link: Complex Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolates From Children With Cystic Fibrosis in the Era of Epidemic Community-Associated Methicillin-Resistant S aureus -- Glikman et al. 133 (6): 1381 -- Chest.

Results: A total of 22 of 34 MRSA isolates (64.7%) from patients with CF belonged to clonal complex (CC) 5 and contained SCCmec II, so-called health-care associated MRSA (HA-MRSA) strains. Nine of 34 MRSA strains (26.5%) were CC 8, and contained SCCmec IV, so-called community-associated MRSA (CA-MRSA) strains. The CA-MRSA strains tended to be isolated from newly colonized CF patients. In contrast, CC8 isolates predominated among the non-CF patients (294 of 331 patients; 88.8%). MRSA isolates from children with CF were more likely to be resistant to clindamycin (65% vs 19%, respectively) and ciprofloxacin (62% vs 17%, respectively) compared with strains from non-CF patients (p < 0.001). There was no difference in the rate of pvl+ isolate recovery from children with CF undergoing a surveillance culture (7 of 23 children) compared with those with pulmonary exacerbation (3 of 11 children; p = 1.0). Conclusions: Both CA-MRSA (CC8) isolates and HA-MRSA (CC5) isolates populate the respiratory tracts of children with CF. HA-MRSA isolates predominated, but CA-MRSA strains predominated among CF patients with newly acquired MRSA strains and among the non-CF patients. The presence of CA-MRSA strains in children with CF was not associated with exacerbation or necrotizing pneumonia.

CA MRSA growing in London

Link: HighWire Press -- Medline Abstract.

We used ciprofloxacin susceptibility as a phenotypic marker of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a London hospital collection of MRSA isolates from inpatients, outpatients and primary-care clinics during 2000-2006. Four-hundred and fifty-eight ciprofloxacin-susceptible (Cip-S) MRSA isolates were reported; antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) type, spa type and the presence of Panton-Valentine leukocidin (PVL) genes were determined for all 194 surviving Cip-S MRSA isolates. Multilocus sequence typing and pulsed-field gel electrophoresis were performed on representative isolates. Clinical and epidemiological features of Cip-S MRSA infections were consistent with CA-MRSA, the incidence of which increased markedly during the study period from 49 in 2000 to 102 in 2006. Most (82.0%) of the surviving Cip-S MRSA isolates were SCCmec IV and 25.3% were PVL-positive. Considerable clonal heterogeneity was noted among the recovered isolates, including the t044/ST80-IV European clone and the PVL-negative t127/ST1-IV clone; PVL-positive t008/ST8-IV (USA300) isolates were rare. Ciprofloxacin susceptibility is a useful screening marker of CA-MRSA strains in London, which are more frequent than previously thought and whose incidence is increasing.

CA MRSA Kills in Japan

Link: HighWire Press -- Medline Abstract.

We present 2 cases with severe necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. The patients were a 89-year-old man and a male student of 15 years of age. Chest X-rays and CT scans demonstrated multiple consolidations with cavitary lesions showing necrotizing pneumonia. MRSA strains were isolated from the sputum cultures on admission in these patients who did not have any established risk factors for MRSA infections such as history of hospitalization, surgery, hemodialysis, the presence of a permanent indwelling catheter or percutaneous medical device, and residence in a long-term care facility. These patients thus satisfied the international criteria for CA-MRSA presented by the Centers for Disease Control and Prevention (CDC). Unfortunately, the first case died of CA-MRSA pneumonia in spite of intensive treatments including anti-MRSA antibiotics. Unlike the severe CA-MRSA cases in western countries, Panton-Valentine leukocidin (PVL) genes were not detected in the present cases, suggesting that factors other than PVL had a significant effect on the severity of necrotizing pneumonia. To the best of our knowledge, this is the first report of severe necrotizing pneumonia caused by CA-MRSA in Japan.

MRSA Staph Infection kills healthy woman

Link: MRSA Staph Infection - California Central Coast News KCOY CBS Channel 12 Santa Maria San Luis Obispo Santa Barbara.

An Arroyo Grande woman has died from the staph infection MRSA, also known a the superbug. Kathie Joe Lippert, 33, died saturday at a local hospital. Family members say she woke up last week and complained about a stiff neck. Her condition worsened over several days. Its still unclear how the bacteria spread through her body. MRSA often infects open sores, cuts and abrasions in the skin.

Deadly superbug surfaces in Australia

Link: Deadly superbug surfaces in Australia.

Health care professionals are warning the MRSA superbug, which already kills 2000 Australian hospital patients a year on average, has evolved into a much more aggressive strain. However, while the antibiotic-resistant bacteria was previously only found in hospitals, doctors have discovered it is now being found in the wider community and can be passed from one member of the public to the other. An investigation by the Sunday program found the new superbug CA-MRSA (Community Aquired Methicillin Resistant Staphylococcus Aureus) can target anyone, including the young and healthy. Sixteen-year-old Sydneysider Reis Gray died late last year from a CA-MRSA infection in his lungs.

Teen's Lip Piercing Leads To MRSA

Link: Teen's Lip Piercing Leads To MRSA - Health News Story - WJAC Johnstown.

A teenager thought he was being trendy when he pierced his lip. Now, he's in a hospital bed with an infection so bad doctors say it could kill him, Kansas City television station KCTV reported. Zeke Wheeler, a 15-year-old freshman at Blue Springs High School, decided three weeks ago to pierce his own lip at home. His mother, Jill Hanlin, said she found him as he was struggling to get the barbell to go all the way through his lip. "He went to the medicine cabinet, got a needle and stuck it the rest of the way through, without the needle being sterilized, of course," Hanlin said. Within days, Wheeler became achy and developed sores on his feet and hands.

Drug-resistant, sometimes lethal infections rising

Link: Drug-resistant, sometimes lethal infections rising | ajc.com.

That such a young man like Darriel Fleming would die so suddenly left his wife reeling with grief and unanswered questions. Although records show doctors reported Fleming's community-associated MRSA death to the state, his widow said she never knew the bacteria killed her husband until contacted by The Atlanta Journal-Constitution. "I'm just so frustrated," said Cynthia Fleming. "I'm just trying to come to grips with this." Hospital records, obtained by the AJC with Cynthia Fleming's authorization, show her husband's infection was caused by MRSA. She wonders whether her husband could have been saved if he had been diagnosed earlier with MRSA. Darriel Fleming, who had heart disease and was a diabetic at risk of skin problems, went to WellStar Cobb Hospital in Austell on June 17 after a painful boil grew on his stomach. In the emergency room, the doctor lanced the abscess and packed it with gauze. The doctor didn't say what it was, said Cynthia Fleming, who went to the hospital with Darriel that day. "My husband kept saying it was a spider bite. I kept saying it doesn't look like a spider bite to me," she said. Darriel Fleming was sent home with a prescription for Bactrim, an antibiotic, although no lab tests were done on the abscess to determine what organism caused it, hospital records show. About three weeks later, on July 5, Fleming developed a fever of 104 degrees. The next day, he went back to the hospital. While a chest X-ray was ordered, again the hospital didn't run any blood tests to look for an infection, hospital and insurance records show. The hospital sent him home with instructions to take Tylenol and drink fluids. Less than 24 hours later, Fleming was extremely ill and back at the emergency room. Despite being put on powerful, intravenous antibiotics, including vancomycin, Fleming's condition declined rapidly. He was put on a ventilator in the hospital's intensive care unit, but died at 3:14 a.m. on July 8. Final blood culture results, which came back after Fleming died, showed the Marietta man's bloodstream infection was caused by MRSA. A separate culture of his abdominal wound — taken less than an hour before he died — found MRSA there as well, hospital records show.

How CA MRSA Complicates Everything

Link: HighWire Press -- Medline Abstract.

Septic cavernous sinus thrombosis is an uncommon clinical syndrome with a high morbidity and mortality. The commonest bacterial pathogen is Staphylococcus aureus. We describe the study of a patient with cavernous sinus thrombosis and meningitis caused by community-acquired methicillin-resistant S. aureus (CA-MRSA) infection. The isolate was genotyped as the ST93 (Queensland) clone of CA-MRSA and carried the Panton-Valentine leucocidin genes. Cure was obtained following prolonged antimicrobial therapy with vancomycin, rifampicin, cotrimoxazole and linezolid. Given the high morbidity and mortality of cavernous sinus thrombosis and the worldwide recent emergence of CA-MRSA, clinicians treating patients with this infection should consider early empirical coverage for CA-MRSA with an antimicrobial agent, such as vancomycin or linezolid, particularly in the presence of suspected facial staphylococcal skin infections. If vancomycin is used, we emphasize that high doses may be required to achieve even low levels in the cerebrospinal fluid.

School Waits 2 Weeks for Death Notice of MRSA Contagious Child

Link: School Waits 2 Weeks for Death Notice of Contagious Child|ABC 7 News.

Parents of students at Bunker Hill Elementary are outraged that the school notified them almost two weeks after a student, who had an extremely contagious disease, died. Parents already knew 11-year-old Dionshae Robinson had died, what they didn't know and just recently found out was the little girl was diagnosed with MRSA, a deadly and extremely contagious anti-biotic resistant staff infection. The school sent out a notice from the Health Department home to parent Monday. 

29% of Australian MRSA community variant

Link: HighWire Press -- Medline Abstract.

The Australian Group on Antimicrobial Resistance studied the epidemiology and outcomes of Staphylococcus aureus bacteraemia in selected Australian hospitals in 2005-06. Seventeen hospital-based laboratories collected basic demographic, susceptibility and patient outcome data on all cases of S. aureus bacteraemia for 5 to 24 months during the study period. There were 1,511 cases of bacteraemia documented, of which 66% occurred in males and 32% originated from vascular access devices. Bacteraemia had a community onset in 60% of cases, although 31% of these were health-care associated. Overall, 57% of episodes were health-care related. Methicillin-resistant Staphylococcus aureus (MRSA) was the responsible pathogen in 24% of instances; of these 53% were of the typical multi-resistant hospital type, and 29% were of the community-associated type. Seven per cent of all staphylococcal bacteraemias were caused by community-associated MRSA strain types, attesting to the growing size of this problem in Australia. Outcomes were available for 51% of cases and in those the all-cause mortality at 7 days or discharge (whichever came earlier) was 11.2%. Age was strongly associated with mortality; the rate for patients aged more than 60 years was 18%. Sepsis originating from intravascular access devices had a lower mortality rate of 5%. S. aureus bacteraemia is a common community and hospital infection with a significant mortality. A nationally co-ordinated program documenting the incidence and outcomes of this disease would likely lead to measures designed to reduce the incidence and improve outcomes of this disease.

CA MRSA emerging worldwide

Link: HighWire Press -- Medline Abstract.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates producing the Panton-Valentine leukocidin (PVL) have been reported worldwide. We describe the molecular characteristics of PVL-positive CA-MRSA strains isolated in Madrid, Spain, and analyze the clinical features of patients infected with these isolates. From 2004 to 2007, we collected 13 PVL-positive MRSA isolates from patients attending to the emergency department. The isolates were genotyped by pulsed-field gel electrophoresis, SCCmec typing, agr polymorphism, and multilocus sequence typing. Susceptibility to 29 antimicrobials was determined by the broth microdilution and by the E-test methods. The isolates belonged to 3 genotypes: ST8-SCCmec IVc (n = 11), ST5-SCCmec IVa (n = 1), and ST80-SCCmec IVc (n = 1). The corresponding agr types were I, II, and III, respectively. Five isolates were resistant to tetracycline and doxycycline, and 1 was resistant to fusidic acid (ST80). The isolates were from children (n = 9) and adults (n = 4), and were associated with skin and soft tissue infections (n = 9), otitis (n = 1), and bacteremia (n = 1). Nine patients were from South America. Our results indicate the transcontinental importation and recent emergence in Spain of PVL-positive CA-MRSA strains belonging to 3 distinct lineages, including 1 predominant (ST8-SCCmec IVc).

MRSA Emerging in Denmark

Link: HighWire Press -- Medline Abstract.

In Copenhagen, methicillin-resistant Staphylococcus aureus (MRSA) accounted for <15 isolates per year during 1980-2002. However, since 2003 an epidemic increase has been observed, with 33 MRSA cases in 2003 and 110 in 2004. We analyzed these 143 cases epidemiologically and characterized isolates by pulsed-field gel electrophoresis, Staphylococcus protein A (spa) typing, multilocus sequence typing, staphylococcal chromosome cassette (SCC) mec typing, and detection of Panton-Valentine leukocidin (PVL) genes. Seventy-one percent of cases were community-onset MRSA (CO-MRSA); of these, 36% had no identified risk factors. We identified 29 spa types (t) and 16 sequence types (STs) belonging to 8 clonal complexes and 3 ST singletons. The most common clonal types were t024/ST8-IV, t019/ST30-IV, t044/ST80-IV, and t008/ST8-IV (USA300). A total of 86% of isolates harbored SCCmec IV, and 44% had PVL. Skin and soft tissue infections dominated. CO-MRSA with diverse genetic backgrounds is rapidly emerging in a low MRSA prevalence area.

Staph infection USA 300 crisis traced to single strain

Link: MyrtleBeachOnline.com | 02/21/2008 | Staph infection crisis traced to single strain.

DeLeo's research, the first study to compare DNA fingerprints of the microbe from various parts of the country, traces the origins of community-acquired MRSA and resolves a heated scientific debate. His findings rule out the previously held notion that multiple strains of MRSA emerged randomly with similar characteristics. MRSA was once a hospital-acquired organism. Now, that it is spreading in communities, the bacteria are being brought into hospitals from the outside.

MRSA Strikes Siouxland Toddler

Link: News::MRSA Strikes Siouxland Toddler.

Meet one-year-old Isabella Nilles. She's happy and healthy now, but just a couple of months ago she was battling MRSA. It was just before Christmas and Isabella developed her first diaper rash. Mom and Dad, Amy and Chris, didn't think much of it. Isabella was teething and running a low-grade fever. So the diaper rash didn't seem alarming... but, Amy Nilles says, "Over a couple of days, there was one spot on her diaper rash that looked like it was getting worse." Christmas Eve Isabella's temperature climbed prompting a trip to the hospital. By they time they got there... she had a 104 degree fever. And that little spot that kept getting worse had dramatically grown in just a couple of days. Amy says, "The spot on her bottom had gone from about the size of a quarter to all the way up to her bikini line all the way down her bottom. I mean her skin was red. It was inflamed. It was hard." Doctors did cultures and other tests to figure out what was... but Isabella and her parents were sent home. Two days later they found out it was MRSA. Amy says, "It was bad. It was really, really scary. She could die." Isabella spent 8 days in the hospital. Doctors had to lance the sore to drain it, and give her IV antibiotics. When she went home, more antibiotics for a month. Where did a one-year-old pick up such a dangerous virus? Her daycare. The provider was unaware another child was a carrier and had an open wound.

280 already dead from CA MRSA in the UK?

Link: Community-acquired MRSA infection often fatal | Health | Reuters.

Among people with a methicillin-resistant Staphylococcus aureus (MRSA) infection caught in the general community (rather than in hospital), more than 20 percent were dead within a year, according to new research findings. Dr. Samy Suissa told Reuters Health that doctors have to be on the lookout "for increasingly frequent community-acquired MRSA infections that too often turn out to be fatal." MRSA infections used to be seen only in hospitalized patients, but nowadays they are occurring more frequently in the general population. Suissa, at McGill University Health Center, Montreal, Canada, and colleagues used a UK general practice database to identify 1439 MRSA patients diagnosed in the community from 2001 to 2004. Each patient was compared with up to 10 matched patients without a MRSA diagnosis. All of the subjects were older than 18 years of age, the average age was 70 years, and none had been hospitalized within the previous 2 years. The patients with MRSA were more likely to have other medical conditions, the researchers report in the online medical journal BMC Medicine. After 1 year of follow-up, 21.8 percent of MRSA patients had died compared to only 5.0 percent of those in the non-MRSA group.

CA MRSA - the best article we've seen in 4 years

Link: Skin Deep: Mark Honigsbaum reports on USA300, a new, flesh-eating superbug | Health and wellbeing | Life and Health.

It's flesh-eating, drug resistant and highly contagious - USA300 is a deadly strain of MRSA that has been identified in San Francisco. But is this new superbug the nightmare public health hazard it's feared to be? And could it spread over here?

Click the link above

GPs on alert for killer MRSA strain in nurseries, schools and the gym

Link: GPs on alert for killer MRSA strain in nurseries, schools and the gym | the Daily Mail.

Family doctors are being put on high alert for cases of a flesh-eating strain of MRSA that thrives in nurseries, classrooms and gyms. GPs will for the first time be given detailed guidelines on how to diagnose and treat the highly infectious bug, thought to be even deadlier than the version sweeping through hospitals. The risk is so serious that the Health Protection Agency and the British Society for Antimicrobial Chemotherapy have come together to draw up the advice, designed to stop the bug running riot across the UK as it has in the U.S. Killer bug: GPs are being warned community-acquired MRSA can be caught in nurseries, schools and gyms Unlike normal MRSA, communityacquired MRSA produces a flesh-eating poison that can rapidly eat away at the lungs, killing within hours. The toxin also destroys infection-fighting white blood cells, putting fit, young, healthy people - including children and babies - at threat.

New Strains of CA MRSA Forecast

Link: Epidemic superbug strains evolved from one bacterium: study - Yahoo! News UK.

Scientists studying the genetic make-up of these bugs, which are resistant to almost all antibiotics, say they are nearly identical clones that have emerged from a single bacterial strain, which they have dubbed USA300. "The USA300 group of strains appears to have extraordinary transmissibility and fitness," said Frank DeLeo, a researcher with the National Institute of Allergy and Infectious Diseases (NIAID) in Hamilton, Montana. "We anticipate that new USA300 derivatives will emerge within the next several years and that these strains will have a wide range of disease-causing potential."

European CA MRSA spreading from Middle East and Med

Link: Epidemiology of European Community-Associated Methicillin-Resistant Staphylococcus aureus Clonal Complex 80 Type IV Strains Isolated in Denmark from 1993 to 2004 -- Larsen et al. 46 (1): 62 -- Journal of Clinical Microbiology.

Compared to the CA-MRSA clone most common in the United States (USA300), the European CA-MRSA clone seems less well adapted to persist in hospital environments. Patients with a recent history of travel or family relation to the Mediterranean or Middle East were highly overrepresented. The epidemiological data indicated that the European CA-MRSA isolates were introduced into Denmark on multiple occasions, paralleled by an increasing level of genetic diversity of the isolates found during the study period. European CA-MRSA has previously been described as a rather uniform clone. However, we found pronounced, diverse pulsed-field gel electrophoresis subtypes, staphylococcal protein A gene (spa) types, and susceptibility patterns.

CA MRSA becoming major issue in hospitals

Link: HighWire Press -- Medline Abstract.

Four hundred and two S. aureus isolates were collected, of which 281 (70%) were MRSA. By clinical definition, 58 (21%) were classified as CA-MRSA and 215 (77%) as HA-MRSA. Among CA-MRSA, 36 (62%) harbored a SCCmec type IV gene. None of the SCCmec type IV CA-MRSA expressed inducible clindamycin resistance (MLSBi). Among 57 HA-MRSA isolates, 31 (54.4%) harbored a SCCmec type IV gene; MLSBi present in 5 (16%). Type IV SCCmec MRSA were most often associated with skin and soft tissue infections (RR 3.34 95% CI 1.43, 7.8). USA300 was the most common genotype among both CA- and HA-MRSA. CONCLUSIONS: Community-associated MRSA is a prominent pathogen with its most common genotype, USA300, representing a significant proportion of CA- and HA-MRSA infections in our institution. Clinical definitions of CA- and HA- status do not correlate well with the genetic definitions, particularly for HA-MRSA.

GPs warned over new community MRSA strains

Link: Pulse - GPs warned over new community MRSA strains.

GPs have been warned of a sharp rise in cases of new virulent strains of community-acquired MRSA that particularly affect children. Cases of Panton Valentine leukocidin (PVL) strains of MRSA have leapt by 36% in the last year, figures from the Health Protection Agency reveal. The rise in cases has prompted the HPA and the Department of Health to work on new guidance, highlighting the potential risk to GPs. In October, Pulse revealed that the department planned to set up a new MRSA surveillance system in primary care after a 90% rise in antibiotics for Staph aureus. PVL strains will be among those subject to surveillance. The HPA said 159 samples of PVL-positive MRSA were identified in 2006, up from 117 the previous year.

GPs handed key MRSA role

Link: Pulse - GPs handed key MRSA role.

GPs are to be drawn on to the frontline of the battle with MRSA with new guidance looking to drive an increase in the number of swabs conducted in patients with suspicious symptoms. The draft guidance, obtained by Pulse, asks GPs to assess the likelihood of infection with community-acquired MRSA through close contacts and recommends empirical prescribing in some cases. The move is the latest bid to stem soaring infection rates outside hospitals and has been prepared as a matter of urgency by the Health Protection Agency and the British Society for Antimicrobial Chemotherapy (BSAC).

UK May Be Unprepared For CA-MRSA Say Researchers

Link: UK May Be Unprepared For CA-MRSA Say Researchers.

Researchers speaking at a conference in Cardiff, UK, earlier today, 28th November, said that while doctors don't know if CA-MRSA (community associated methicillin resistant Staphylococcus aureus) is likely to spread as fast in the UK as it has in the US, they are worried about it. The new strains of CA-MRSA appear to stick to damaged skin and airways more easily than the hospital based MRSA strains prevalent in the UK, and they reproduce more quickly. The researchers, led by Dr Marina Morgan from the Royal Devon & Exeter Foundation NHS Trust, told delegates at the Federation of Infection Societies Conference 2007 at the University of Cardiff, that if CA-MRSA spreads in the UK as fast as it did in the US, then many patients will be admitted to hospital with a wrong diagnosis and given the wrong antibiotics, and by the time doctors realise what is happening it could be too late.

Identification of novel cytolytic peptides as key virulence determinants for community-associated MRSA.

Link: Identification of novel cytolytic peptides as key virulence determinants for community-associated MRSA..

Here we describe a class of secreted staphylococcal peptides that have a remarkable ability to recruit, activate and subsequently lyse human neutrophils, thus eliminating the main cellular defense against S. aureus infection. These peptides are produced at high concentrations by standard CA-MRSA strains and contribute significantly to the strains' ability to cause disease in animal models of infection. Our study reveals a previously uncharacterized set of S. aureus virulence factors that account at least in part for the enhanced virulence of CA-MRSA.

Taboo no longer: State to start regulating body art industry

Link: Taboo no longer: State to start regulating body art industry - NewsFlash - mlive.com.

As once-taboo piercings and tattoos grow in popularity, Michigan wants to start regulating the body art industry. Tattoo artists and body piercers are asking what took so long. "We are dealing with blood and body fluids. We're not just cutting hair," said Kris Lachance, who owns the Splash of Color Tattoo & Piercing Studio in East Lansing, located just steps from Michigan State University.

MRSA as much a challenge as climate change?

Link: Battle to beat the superbugs - Health - Specials - smh.com.au.

Their spread across Australia and the world is one of the reasons a leading Sydney microbiologist, Professor John Tapsall of the University of NSW, describes the escalating problem of drug resistance as the microbiological equivalent of climate change. "The threat is real, the science is in, the time for action is now," he says. The problem was reinforced this week with the outbreak of a hospital superbug, vancomycin-resistant Enterococcus, or VRE, in Queensland. More than 20 patients at the Royal Brisbane and Women's Hospital tested positive for normally harmless intestinal bacteria that have become resistant to a range of antibiotics including one of the last resort drugs, vancomycin.

Compuers includedn in MRSa clean up

Link: Irish Medical Times.

UK will 'debug' MRSA computers A 'deep clean' initiative in the UK's hospitals will be extended to include computers and IT systems in an effort to wipe out viruses – the biological kind – and other 'superbugs' lingering in these environments IT and telephone equipment have been included in the UK’s Department of Health’s list of items be subjected to a rigorous cleansing, when all NHS trusts are given a ‘deep clean’ to tackle infections such as MRSA and c difficile. Every hospital in Britain is to undergo a ward-by-ward ‘deep clean’ within the next year to rid them of ‘superbugs’ such as c difficile, Prime Minister Gordon Brown announced at the Labour Party conference in September.

Piercings could be MRSA issue

Link: The Journal Times Online > Life > Battle of the Bugs: MRSA isn't a new problem.

“By about ’52, ’53, you had microbiologists saying these organisms can become resistant. So the microbiologists knew a long time ago that this was happening. It took the rest of the world another 50 years to catch up, quite literally.” Click to learn more... “You know, we stared seeing MRSA back in the 60s,” said Dr. Robert Gullberg, an infectious disease specialist with Wheaton Franciscan Healthcare-All Saints. It appeared first in Southeast Asia and spread from there. “When I came to Racine in 1986 we rarely saw a MRSA infection.” About 10 years ago, about 5 percent of the staph organisms isolated at St. Mary’s hospital were resistant, he said. The fraction was 10 to 12 percent five years ago. “Now we’re up to, I believe, approximately 40 percent of our isolates of staph are MRSA.” That mirrors what has happened around the country, he said. And the strains of MRSA found here are the same as those found in other parts of the country, meaning that there is enough movement among people to spread the same strain of bacteria. “We see women with MRSA infection in their earlobes from pierced ears,” Gullberg said “We see high school football players colonized with it, which means the mats are often getting colonized with MRSA.”

MRSA takes toll on daughter's health, family's finances

Link: MRSA takes toll on daughter's health, family's finances | APP.com | Asbury Park Press.

t wasn't until Parker landed in the Hospital of the University of Pennsylvania in Philadelphia in July, after being transferred there from Jersey Shore University Medical Center in Neptune, that she and her family learned that the sores on her scalp that wouldn't heal were caused by methicillin-resistant Staphylococcus aureus, the antibiotic-resistant skin infection commonly known as MRSA. Parker has been battling MRSA for almost six months, said her mother, Kim Ferrara, an 8-year veteran of the Ocean County Sheriff's Department. The young woman has been hospitalized seven times since May 30, Ferrara said. It has been a harrowing experience for her and her family.

Vigilant county a step ahead on MRSA | TheNewsTribune.com | Tacoma, WA

Link: A step ahead on MRSA | TheNewsTribune.com | Tacoma, WA.

They recognized the problem earlier than most, in part, because of an MRSA lung infection in a young boy in the late 1990s. After forming a task force in 2000, health officials began tracking MRSA infections in the county. The group also worked with doctors’ offices, nursing homes, pharmacies, schools and hospitals to ensure infections were identified early, treated correctly or prevented in the first place. Those early efforts to fight MRSA – a version of a generally harmless skin bacteria – were among the first anywhere, says state health department spokesman Tim Church. The Pierce County effort “is a model … for MRSA public awareness around the country,” he said. “Pierce County has really been ahead when it comes to looking at MRSA, gathering information and knowing what to do about it.” That’s good, because, as elsewhere in the country, MRSA infections are more common in Pierce County than they used to be. According to the county Health Department, one of the few in the state that track MRSA, 696 residents developed infections in 2001. In 2006, the most recent data available, MRSA infected 4,012. It’s hard to know what’s behind the increase, said Dr. David Bales, an infectious disease expert and chairman of the Pierce County task force. People might be finding more MRSA infections because there are more of them, he said. It also could be that local medical providers are looking for them more than in the past, or a combination of both.

Hawaii MRSA death sparking action

Link: starbulletin.com | News | /2007/11/26/.

The death in Hawaii of an entertainer from a drug-resistant staph infection has local officials emphasizing extra vigilance to keep the bug from spreading in public restrooms and school locker rooms. What was unusual about the death of singer Rhonda Bryers Sept. 28 and a student in Virginia last month is that the infections were acquired in community settings rather than in a hospital, officials said. A recent Centers for Disease Control study found that methicillin-resistant staph A contributed to the deaths of almost 19,000 people in 2005 -- more than the death rate from AIDS. Hawaii has the highest rate of MRSA infections of any state, according to survey information presented to the Association for Professionals in Infection Control and Epidemiology.

CA MRSA doesn't always need drugs

Link: Characterization of Community-Acquired Staphylococcus aureus Infections in Children -- Johnson et al. 41 (9): 1361 -- The Annals of Pharmacotherapy.

RESULTS: Seventy patients were included for analysis (CA-MRSA, n = 51; community-acquired methicillin-susceptible S. aureus [CA-MSSA], n = 19). No statistically significant differences were noted between the number of CA-MRSA infections and the total CA-SAI (9/15 in 2004 vs 42/55 in 2005; p = 0.15). Approximately 75% of patients with CA-SAI were admitted to the hospital with no significant difference in length of stay. Ninety percent of CA-SAI were skin and soft tissue infections. There was a significant difference between groups with cutaneous abscesses (CA-MRSA, n = 37 vs CA-MSSA, n = 6; p = 0.002). Greater than 95% of all isolates were susceptible to vancomycin and trimethoprim/sulfamethoxazole. Half of CA-MRSA patients received inappropriate antibiotic therapy with �-lactam antibiotics or clindamycin without confirmatory disk diffusion test. Twenty-five (49%) patients with CA-MRSA received surgical debridement (S/D) and/or incision and drainage (I/D) with concomitant antibiotic therapy. Four patients with CA-MRSA were rehospitalized for subsequent infections; all 4 received appropriate antibiotic therapy. CONCLUSIONS: A noticeable increase in CA-MRSA infections with cutaneous abscess between 2004 and 2005 was noted. In patients receiving inappropriate antibiotic therapy, treatment success was attributed to concomitant S/D and I/D. Further analysis should focus on the impact of antibiotic therapy alone or in combination with S/D and I/D on the incidence of subsequent CA-MRSA infections.

Very Rare Spider Gets Blame - Should be CA MRSA

Link: Reports of Envenomation by Brown Recluse Spiders Exceed Verified Specimens of Loxosceles Spiders in South Carolina -- Frithsen et al. 20 (5): 483 -- The Journal of the American Board of Family Medicine.

Purpose: To determine whether the number of brown recluse spider bites diagnosed by South Carolina physicians coincides with evidence of brown recluse spiders found in the state. Methods: Brown recluse spider bite diagnosis data were extracted from 1990 and 2004 surveys of South Carolina physicians. This was compared with the known historical evidence of brown recluse spiders collected in South Carolina and derived from various sources, including state agencies, arachnologists, and museum specimens. Results: South Carolina physicians diagnosed 478 brown recluse spider bites in 1990 and 738 in 2004. Dating to 1953, 44 brown recluse spider specimens have been verified from 6 locations in South Carolina. Discussion: The number of brown recluse bites reportedly diagnosed in South Carolina greatly outnumbers the verified brown recluse specimens that have been collected in the state. The pattern of bite diagnoses outnumbering verified brown recluse specimens has been reported in other areas outside of this spider's known endemic range.

Incision and drainage best for CA MRSA - not drugs

Link: Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community Methicillin-Resistant Staphylococcus aureus Infection -- Rajendran et al., 10.1128/AAC.00377-07 -- Antimicrobial Agents and Chemotherapy.

Background– Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft-tissue infections, may no longer be appropriate for these infections because of increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used. Methods– We conducted a randomized, double-blind trial of 166 out-patient subjects comparing placebo to cephalexin 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage. Results– S. aureus was isolated from 70.4% of abscess cultures. 87.8% of the isolates tested were methicillin-resistant S. aureus (MRSA), 93% of which were positive for PVL genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 - 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval 0.74 - 0.91,) in the 82 cephalexin recipients, (difference in the two proportions 0.0006, 95% confidence interval -0.0461 to 0.0472), p = 0.25. Conclusions– The 90.5% cure rate observed in the placebo arm and 84.1% cure rate in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.

CA MRSA could complicate breast feeding

Link: Arch Surg -- Abstract: Breast Abscess Bacteriologic Features in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus Epidemics, September 2007, Moazzez et al. 142 (9): 881.

Main Outcome Measures  The microbiologic features and sensitivities of breast abscesses. Results  Of 46 specimens only 28 showed bacterial yield (61%). Of these, 11 (39%) were polymicrobial, for an average of 1.4 isolates per specimen. The most common organism was S aureus, present in 12 of 37 aerobic cultures (32%), with MRSA in 7 (58%). The remaining organisms included coagulase-negative Staphylococcus (16%), diphtheroids (16%), Pseudomonas aeruginosa (8%), Proteus mirabilis (5%), and other isolates (22%). All MRSA was sensitive to clindamycin, trimethoprim-sulfamethoxazole, and linezolid. Only 2 patients (29%) were sensitive to levofloxacin. Two anaerobic cultures were positive for Propionibacterium acnes and Peptostreptococcus anaerobius. Conclusions  Staphylococcus aureus is the most common pathogenic organism in modern breast abscesses. Many breast abscesses have community-acquired MRSA, with more than 50% of all S aureus and 19% of all cultures being MRSA. This finding parallels the local and national increases in MRSA reported in other soft-tissue infections. With increasing bacterial resistance and more minimally invasive management of breast abscesses, understanding the current bacteriologic profile of these abscesses is essential to determining the correct empirical antibiotic drug therapy.