Editorial

Community-acquired MRSA: A Notable Adversary

Authors: John S. Francis, MD, PHD, Karen Carroll, MD

Abstract

In this issue, Clancy et al1 describe their findings from a retrospective cohort study conducted in 2003 on 193 patients evaluating the epidemiology, outcomes, and molecular characterization of community-acquired Staphylococcus aureus (CA-SA) infections from an integrated health care system serving the center of metropolitan Denver. Their data confirm the observation of others in the United States 2–4 and worldwide5 that community-acquired methicillin-resistant S aureus (CA-MRSA) strains have markedly increased, rising from 6 to 45% (P < 0.001) in Denver over a period of 2 years, and that the typical risk factors associated with MRSA may not be present in such individuals. Clancy et al found that their CA-MRSA strains were mostly of a similar pulsed-field type (speculated by the authors to be USA 300) and more likely to have high rates of quinolone resistance (51%) compared with methicillin-susceptible strains (3%). In addition, 10 of 20 CA-MRSA isolates tested positive for the Panton-Valentine leukocidin (PVL) gene, which code for a known CA-SA virulence factor.1

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References

1. Clancy MJ, Graepler A, Breese PE, et al. The widespread emergence of methicillinresistance in community-acquired Staphylococcus aureus infections in Denver. South Med J 2005;98:1069–1075.
 
2. Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillin- resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.
 
3. Buckingham SC, McDougal LK, Cathey LD, et al. Emergence of community- associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee children’s hospital. Pediatr Infect Dis J2004;23:619–624.
 
4. Carleton HA, Diep BA, Charlebois ED, et al. Community-adapted methicillin- resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis 2004;190:1730–1738.
 
5. Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin- resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003;9:978–984.
 
6. Robinson DA, Kearns AM, Holmes A, et al. Re-emergence of early pandemic Staphylococcus aureus as a community-acquired methicillin-resistant clone. Lancet 2005;365:1256–1258.
 
7. Konig B, Prevost G, Piemont Y, et al. Effects of Staphylococcus aureus leukocidins on inflammatory mediator release from human granulocytes. J Infect Dis 1995;171:607–613.
 
8. Ward PD, Turner WH. Identification of staphylococcal Panton-Valentine leukocidin as a potent dermonecrotic toxin. Infect Immun 1980;27:393–397.
 
9. Liassine N, Auckenthaler R, Descombes MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus isolated in Switzerland contains the Panton-Valentine leukocidin or exfoliative toxin genes. J Clin Microbiol 2004;42:825–828.
 
10. Baba T, Takeuchi F, Kuroda M, et al. Genome and virulence determinants of high virulence community acquired MRSA. Lancet 2002;359:1819–1827.
 
11. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352:1445–1453.
 
12. Sattler CA, Mason Jr., EO, Kaplan, SL. Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children. Pediatr Infect Dis J 2002;21:910–916.
 
13. Groom AV, Wolsey DH, Naimi TS, et al. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:1201–1205.
 
14. Gillet Y, Issartel B, Banhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotizing pneumonia in young immunocompetent patients. Lancet 2002;359:753–759.
 
15. Ellis MW, Hospenthal DR, Dooley DP, et al. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39:971–979.
 
16. Wunderink RG, Rello J, Cammarata SK, et al. Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest2003;124:1789–1797.
 
17. Siberry GK, Tekle T, Carroll K, Dick J. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis2003;37:1257–1260.
 
18. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436–1444.
 
19. Ruiz ME, Yohannes S, Wladyka CG. Pyomyositis caused by methicillin-resistant Staphylococcus aureus. N Engl J Med 2005;352:1488–1489.
 
20. Kravitz GR, Dries DJ, Peterson ML, et al. Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis 2005;40:941–947.