Current Infectious Disease Reports

, Volume 9, Issue 5, pp 391–397 | Cite as

Community-associated methicillin-resistant Staphylococcus aureus: Incidence, clinical presentation, and treatment decisions



Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been reported with increasing frequency from many parts of the world. Most infections involve the skin and soft tissue structures, and CA-MRSA is now the most commonly identifiable cause of purulent skin and soft tissue infections. The spectrum of disease can range from simple cutaneous abscesses to fulminant necrotizing infection. CA-MRSA strains, in contrast to healthcare-associated strains, are generally extra virulent and produce more toxins. Unlike the healthcare-associated strains, they demonstrate variable susceptibility patterns to various classes of antibiotics. Empiric antibiotic therapy for patients with purulent skin and soft tissue infection and for those presenting with severe, life-threatening infections should include an agent active against CA-MRSA.


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References and Recommended Reading

  1. 1.
    Chambers HF: The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 2001, 7:178–182.PubMedCrossRefGoogle Scholar
  2. 2.
    Kluytmans J, van Belkum A, Verbrugh H: Nasal carriage of Staphylococcus aureus: Epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997, 10:505–520.PubMedGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Fridkin SK, Hageman JC, Morrison M, et al.: Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005, 352:1436–1444.PubMedCrossRefGoogle Scholar
  5. 5.
    Kazakova SV, Hageman JC, Matava M, et al.: A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005, 352:468–475.PubMedCrossRefGoogle Scholar
  6. 6.
    Lindenmayer JM, Schoenfeld S, O’Grady R, et al.: Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998, 158:895–899.PubMedCrossRefGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention: Methicillin-resistant Staphylococcus aureus infections in correctional facilities-Georgia, California, and Texas, 2001–2003. MMWR Morb Mortal Wkly Rep 2003, 52:992–995.Google Scholar
  8. 8.
    Centers for Disease Control and Prevention: Methicillin-resistant Staphylococcus aureus infections among competitive sports participants-Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR Morb Mortal Wkly Rep 2003, 52:793–795.Google Scholar
  9. 9.
    Frazee BW, Lynn J, Charlebois ED, et al.: High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 2005, 45:311–320.PubMedCrossRefGoogle Scholar
  10. 10.
    Moran GJ, Amii RN, Abrahamian FM, et al.: Methicillinresistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005, 11:928–930.PubMedGoogle Scholar
  11. 11.
    Moran GJ, Krishnadasan A, Gorwitz RJ, et al.: Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006, 355:666–674.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Gillet Y, Issartel B, Vanhems 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention: Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus-Minnesota and North Dakota, 1997-1999. MMWR Morb Mortal Wkly Rep 1999, 48:707–710.Google Scholar
  15. 15.
    Naimi TS, LeDell KH, Como-Sabetti K, et al.: Comparison of community-and health care-associated methicillinresistant Staphylococcus aureus infection. JAMA 2003, 290:2976–2984.PubMedCrossRefGoogle Scholar
  16. 16.
    Fey PD, Said-Salim B, Rupp ME, et al.: Comparative molecular analysis of community-or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2003, 47:196–203.PubMedCrossRefGoogle Scholar
  17. 17.
    Deresinski S: Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic odyssey. Clin Infect Dis 2005, 40:562–573.PubMedCrossRefGoogle Scholar
  18. 18.
    Gorwitz RJ, Jernigan DB, Powers JH, et al.: Strategies for clinical management of MRSA in the community. Summary of an experts’ meeting convened by the Centers for Disease Control and Prevention, 2006. Available at http://www.cdc. gov/ncidod/dhqp/ar_mrsa_ca.html. Accessed June 19, 2007.
  19. 19.
    Diep BA, Gill SR, Chang RF, et al.: Complete genome sequence of USA300, an epidemic clone of communityacquired methicillin-resistant Staphylococcus aureus. Lancet 2006, 367:731–739.PubMedCrossRefGoogle Scholar
  20. 20.
    Voyich JM, Otto M, Mathema B, et al.: Is Panton-Valentine leukocidin the major virulence determinant in communityassociated methicillin-resistant Staphylococcus aureus disease? J Infect Dis 2006, 194:1761–1770.PubMedCrossRefGoogle Scholar
  21. 21.
    Lina G, Piemont Y, Godail-Gamot F, et al.: Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999, 29:1128–1132.PubMedCrossRefGoogle Scholar
  22. 22.
    Vandenesch F, Naimi T, Enright MC, et al.: Communityacquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003, 9:978–984.PubMedGoogle Scholar
  23. 23.
    Gillet Y, Issartel B, Vanhems 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.PubMedCrossRefGoogle Scholar
  24. 24.
    Miller LG, Perdreau-Remington F, Bayer AS, et al.: Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis 2007, 44:471–482.PubMedCrossRefGoogle Scholar
  25. 25.
    Swartz MN: Cellulitis. N Engl J Med 2004, 350:904–912.PubMedCrossRefGoogle Scholar
  26. 26.
    Squire BT, Fox JC, Anderson C: ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005, 12:601–606.PubMedCrossRefGoogle Scholar
  27. 27.
    Tayal VS, Hasan N, Norton HJ, et al.: The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med 2006, 13:384–388.PubMedCrossRefGoogle Scholar
  28. 28.
    Lee MC, Rios AM, Aten MF, et al.: Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2004, 23:123–127.PubMedCrossRefGoogle Scholar
  29. 29.
    Miller LG, Quan C, Shay A, et al.: A prospective investigation of outcomes after hospital discharge for endemic, community-acquired methicillin-resistant and-susceptible Staphylococcus aureus skin infection. Clin Infect Dis 2007, 44:483–492.PubMedCrossRefGoogle Scholar
  30. 30.
    Gilbert DN, Moellering RC, Eliopoulos GM, et al.: The Sanford Guide to Antimicrobial Therapy, edn 37. Sperryville, VA: Antimicrobial Therapy Inc.; 2007.Google Scholar
  31. 31.
    Yu VL, Goetz A, Wagener M, et al.: Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis. N Engl J Med 1986, 315:91–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Ruhe JJ, Monson T, Bradsher RW, et al.: Use of long-acting tetracyclines for methicillin-resistant Staphylococcus aureus infections: case series and review of the literature. Clin Infect Dis 2005, 40:1429–1434.PubMedCrossRefGoogle Scholar
  33. 33.
    Lewis JS 2nd, Jorgensen JH: Inducible clindamycin resistance in Staphylococci: should clinicians and microbiologists be concerned? Clin Infect Dis 2005, 40:280–285.PubMedCrossRefGoogle Scholar
  34. 34.
    Siberry GK, Tekle T, Carroll K, et al.: Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis 2003, 37:1257–1260.PubMedCrossRefGoogle Scholar
  35. 35.
    Phillips S, MacDougall C, Holdford DA: Analysis of empiric antimicrobial strategies for cellulitis in the era of methicillin-resistant Staphylococcus aureus. Ann Pharmacother 2007, 41:13–20.PubMedGoogle Scholar
  36. 36.
    Betriu C, Redondo M, Boloix A, et al.: Comparative activity of linezolid and other new agents against methicillin-resistant Staphylococcus aureus and teicoplanin-intermediate coagulase-negative staphylococci. J Antimicrob Chemother 2001, 48:911–913.PubMedCrossRefGoogle Scholar
  37. 37.
    Welshman IR, Sisson TA, Jungbluth GL, et al.: Linezolid absolute bioavailability and the effect of food on oral bioavailability. Biopharm Drug Dispos 2001, 22:91–97.PubMedCrossRefGoogle Scholar
  38. 38.
    Gee T, Ellis R, Marshall G, et al.: Pharmacokinetics and tissue penetration of linezolid following multiple oral doses. Antimicrob Agents Chemother 2001, 45:1843–1846.PubMedCrossRefGoogle Scholar
  39. 39.
    Kutscha-Lissberg F, Hebler U, Muhr G, et al.: Linezolid penetration into bone and joint tissues infected with methicillin-resistant staphylococci. Antimicrob Agents Chemother 2003, 47:3964–3966.PubMedCrossRefGoogle Scholar
  40. 40.
    Weigelt J, Itani K, Stevens D, et al.: Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother 2005, 49:2260–2266.PubMedCrossRefGoogle Scholar
  41. 41.
    Gerson SL, Kaplan SL, Bruss JB, et al.: Hematologic effects of linezolid: summary of clinical experience. Antimicrob Agents Chemother 2002, 46:2723–2726.PubMedCrossRefGoogle Scholar
  42. 42.
    Carpenter CF, Chambers HF: Daptomycin: another novel agent for treating infections due to drug-resistant grampositive pathogens. Clin Infect Dis 2004, 38:994–1000.PubMedCrossRefGoogle Scholar
  43. 43.
    Stein GE, Craig WA: Tigecycline: a critical analysis. Clin Infect Dis 2006, 43:518–524.PubMedCrossRefGoogle Scholar
  44. 44.
    Jones RN, Ballow CH, Acar J, et al.: World-wide evaluation of quinupristin-dalfopristin (Q/D) (Synercid): Antimicrobial activity directed against resistant Grampositive pathogens: Report from the global SMART study [abstract 1262]. 39th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology; 1999:263.Google Scholar
  45. 45.
    Drew RH, Perfect JR, Srinath L, et al.: Treatment of methicillin-resistant Staphylococcus aureus infections with quinupristin-dalfopristin in patients intolerant of or failing prior therapy. J Antimicrob Chemother 2000, 46:775–784.PubMedCrossRefGoogle Scholar
  46. 46.
    Nichols RL, Graham DR, Barriere SL, et al.: Treatment of hospitalized patients with complicated gram-positive skin and skin structure infections: two randomized, multicenter studies of quinupristin/dalfopristin versus cefazolin, oxacillin or vancomycin. Synercid Skin and Skin Structure Infection Group. J Antimicrob Chemother 1999, 44:263–273.PubMedCrossRefGoogle Scholar
  47. 47.
    Jauregui LE, Babazadeh S, Seltzer E, et al.: Randomized, double-blind comparison of once-weekly dalbavancin versus twice-daily linezolid therapy for the treatment of complicated skin and skin structure infections. Clin Infect Dis 2005, 41:1407–1415.PubMedCrossRefGoogle Scholar
  48. 48.
    Stevens DL, Bisno AL, Chambers HF, et al.: Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005, 41:1373–1406.PubMedCrossRefGoogle Scholar
  49. 49.
    Kuehnert MJ: Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006, 193:172–179.PubMedCrossRefGoogle Scholar
  50. 50.
    Harbarth S, Dharan S, Liassine N, et al.: Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999, 43:1412–1416.PubMedGoogle Scholar
  51. 51.
    Simor AE, Phillips E, McGeer A, et al.: Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007, 44:178–185.PubMedCrossRefGoogle Scholar
  52. 52.
    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.PubMedCrossRefGoogle Scholar
  53. 53.
    Sandri AM, Dalarose MG, Ruschel de Alcantara L, et al.: Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA. Infect Control Hosp Epidemiol 2006, 27:185–187.PubMedCrossRefGoogle Scholar
  54. 54.
    Kampf G, Jarosch R, Ruden H: Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1998, 38:297–303.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of Emergency MedicineOlive View-UCLA Medical CenterSylmarUSA

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