Review article
Serious infections due to methicillin-resistant Staphylococcus aureus: An evolving challenge for physicians

https://doi.org/10.1016/j.ejim.2008.08.016Get rights and content

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized major cause of nosocomial infection worldwide. During the past decade, however, the epidemiology of staphylococcal infections has partially changed, with an increase in the number of patients who acquire infections in the community. The changing epidemiology is a cause for concern among physicians, leading to an increase in the number of patients with infections due to MRSA diagnosed at hospital admission and in the emergency department. The aims of this article are to review the current state of knowledge regarding MRSA infections, to identify those factors which may help physicians to recognize the patients at high risk, and to manage these infections appropriately.

Introduction

Since the apparition of methicillin resistance of Staphylococcus aureus in 1961, methicillin-resistant staphylococci have become widespread in hospitals around the world, and nowadays represent the most common causes of bacterial nosocomial infection [1]. In the past, acquisition of methicillin-resistant staphylococci colonization or infection was generally considered to be restricted to the nosocomial setting. In the last decade the epidemiology of staphylococcal infections has partially changed [2] as a consequence of two major factors: 1) the increasing number of outpatients with extensive health-care contact, and 2) the emergence of community-acquired (CA) clones of methicillin-resistant staphylococci. Because of that, an increasing prevalence of health-care-associated (HCA) [3] or CA infections has been registered both in the United States and Europe [4].

The changing epidemiology of methicillin-resistant staphylococcal infections is a cause for concern among physicians. The purposes of this article are, starting by the description of illustrative cases, to review the current state of knowledge regarding methicillin-resistant staphylococcal infections, to identify those factors which may help physicians to recognize the patients at high risk, and to manage these infections appropriately.

Section snippets

Illustrative case

A 59-year-old woman was admitted to the hospital because the onset of fever, obnubilation and dyspnoea. Her medical history was notable for a diagnosis of myelodisplastic syndrome, autoimmune haemolytic anemia, chronic B-related hepatitis, and diabetes mellitus type 2. Within the last three months the patient had multiple hospital admissions due to episodes of acute gastrointestinal bleeding. Seven days before admission the patient had a totally implantable central venous access device

Conclusions

During the last decade important changes in the epidemiology of infections due to MRSA have occurred. CA-MRSA infections represent a major cause of concern for physicians, who must consider this microbial etiology not only in cases of nosocomial acquisition but also in patients coming from the community without any risk factors for MRSA colonization or infection. Clinicians should recognize, on the basis of the presence of specific risk factors, those patients who have a high likelihood of

Learning points

  • Methicillin-resistant S. aureus (MRSA), is not restricted to the nosocomial setting but is nowadays spreading in the community.

  • The community spread of MRSA arises from two patient populations: patients with strains that have been acquired during an exposure to a health-care setting; patients with community-acquired strains, with few or no risk factors, including athletes, prisoners, and healthy children.

  • Patients with health-care-associated-MRSA infections can be identified on the basis of

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