MRSA infection of buttocks, vulva, and genital tract in women

Article

Abstract

Staphylococcus aureus, although a common commensal bacterium, is a frequent cause of skin and soft tissue infections as well as life-threatening blood stream infections. Resistance to methicillin, which previously was associated with only hospitalized patients, has become a common community-based phenomenon. Less well known is S. aureus vaginal colonization and heterosexual transmission, mainly by skin-mucosa contact. Recognizing the vagina as a reservoir is important and should not be ignored, particularly in women presenting with recurrent genital and buttock boils or if their sexual partner has such infections. Vaginal cultures should be obtained from such women; if the vagina is found to be colonized, eradication of S. aureus from the vagina should be attempted to reduce infection recurrence.

References and Recommended Reading

  1. 1.
    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
  2. 2.
    Chen KT, Huard RC, Della-Latta P, et al.: Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006, 108(3 Pt 1):482–487.PubMedGoogle Scholar
  3. 3.
    Andrews WW, Schelonka R, Waites K, et al.: Genital tract methicillin-resistant Staphylococcus aureus: risk of vertical transmission in pregnant women. Obstet Gynecol 2008, 111:113–118.PubMedGoogle Scholar
  4. 4.
    Diekema DJ, Pfaller MA, Schmitz FJ, et al.: Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 2001, 32(Suppl 2):S114–S132.CrossRefPubMedGoogle Scholar
  5. 5.
    Begier EM, Frenette K, Barrett NL, et al.: A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004, 39:1446–1453.CrossRefPubMedGoogle Scholar
  6. 6.
    Matouskova I, Janout V: Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008, 152:191–202.PubMedGoogle Scholar
  7. 7.
    Hurst V, Grossman M, Ingram FR, et al.: Hospital laundry and refuse chutes as source of staphylococcic cross-infection. J Am Med Assoc 1958, 167:1223–1229.PubMedGoogle Scholar
  8. 8.
    Neely AN, Maley MP: Survival of enterococci and staphylococci on hospital fabrics and plastic. J Clin Microbiol 2000, 38:724–726.PubMedGoogle Scholar
  9. 9.
    Wolinsky E, Lipsitz PJ, Mortimer EA, et al.: Acquisition of staphylococci by newborns. Direct versus indirect transmission. Lancet 1960, 2:620–622.CrossRefPubMedGoogle Scholar
  10. 10.
    Lin YC, Lauderdale TL, Lin HM, et al.: An outbreak of methicillin-resistant Staphylococcus aureus infection in patients of a pediatric intensive care unit and high carriage rate among health care workers. J Microbiol Immunol Infect 2007, 40:325–334.PubMedGoogle Scholar
  11. 11.
    McBryde ES, Bradley LC, Whitby M, et al.: An investigation of contact transmission of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2004, 58:104–108.CrossRefPubMedGoogle Scholar
  12. 12.
    Shinefield HR, Ruff NL: Staphylococcal infections: a historical perspective. Infect Dis Clin North Am 2009, 23:1–15.CrossRefPubMedGoogle Scholar
  13. 13.
    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
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    Todd JK: Toxic shock syndrome. Clin Microbiol Rev 1988, 1:432–446.PubMedGoogle Scholar
  16. 16.
    Katayama Y, Ito T, Hiramatsu K: A new class of genetic element, staphylococcus cassette chromosome mec, encodes methicillin resistance in Staphylococcus aureus. Antimicrob Agents Chemother 2000, 44:1549–1555.CrossRefPubMedGoogle Scholar
  17. 17.
    Panlilio AL, Culver DH, Gaynes RP, et al.: Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992, 13:582–586.CrossRefPubMedGoogle Scholar
  18. 18.
    National Nosocomial Infections Surveillance System: National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004, 32:470–485.CrossRefGoogle Scholar
  19. 19.
    Chambers HF: The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 2001, 7:178–182.CrossRefPubMedGoogle Scholar
  20. 20.
    Methicillin-resistant Staphylococcus aureus infections in correctional facilities-Georgia, California, and Texas, 2001–2003. MMWR Morb Mortal Wkly Rep 2003, 52:992–996.Google Scholar
  21. 21.
    Moran GJ, Amii RN, Abrahamian FM, et al.: Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005, 11:928–930.PubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    Young DM, Harris HW, Charlebois ED, et al.: An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients. Arch Surg 2004, 139:947–951; discussion 51–53.CrossRefPubMedGoogle Scholar
  24. 24.
    Minnesota Department of Health: Methicillin-resistant Staphylococcus aureus (MRSA), 2004. Available at http://www.health.state.mn.us/divs/idepc/newsletters/dcn/sum04/mrsa.html. Accessed June 2009.
  25. 25.
    Centers for Disease Control and Prevention: Communityassociated MRSA information for clinicians. Available at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_clinicians.html#5. Accessed June 2009.
  26. 26.
    McDougal LK, Steward CD, Killgore GE, et al.: Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003, 41:5113–5120.CrossRefPubMedGoogle Scholar
  27. 27.
    Ma XX, Ito T, Tiensasitorn C, et al.: Novel type of staphylococcal cassette chromosome mec identified in community-acquired methicillin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother 2002, 46:1147–1152.CrossRefPubMedGoogle Scholar
  28. 28.
    Naimi TS, LeDell KH, Como-Sabetti K, et al.: Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003, 290:2976–2984.CrossRefPubMedGoogle Scholar
  29. 29.
    Chien Y, Cheung AL: Molecular interactions between two global regulators, sar and agr, in Staphylococcus aureus. J Biol Chem 1998, 273:2645–2652.CrossRefPubMedGoogle Scholar
  30. 30.
    Sabersheikh S, Saunders NA: Quantification of virulence-associated gene transcripts in epidemic methicillin resistant Staphylococcus aureus by real-time PCR. Mol Cell Probes 2004, 18:23–31.CrossRefPubMedGoogle Scholar
  31. 31.
    Deresinski S: Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic odyssey. Clin Infect Dis 2005, 40:562–573.CrossRefPubMedGoogle Scholar
  32. 32.
    Saiman L, O’Keefe M, Graham PL 3rd, et al.: Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003, 37:1313–1319.CrossRefPubMedGoogle Scholar
  33. 33.
    O’Brien FG, Pearman JW, Gracey M, et al.: Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 1999, 37:2858–2862.PubMedGoogle Scholar
  34. 34.
    Seybold U, Kourbatova EV, Johnson JG, et al.: Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006, 42:647–656.CrossRefPubMedGoogle Scholar
  35. 35.
    Patel M, Kumar RA, Stamm AM, et al.: USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. J Clin Microbiol 2007, 45:3431–3433.CrossRefPubMedGoogle Scholar
  36. 36.
    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.CrossRefPubMedGoogle Scholar
  37. 37.
    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.CrossRefPubMedGoogle Scholar
  38. 38.
    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.CrossRefPubMedGoogle Scholar
  39. 39.
    Kalorin CM, Tobin EH: Community associated methicillin resistant Staphylococcus aureus causing Fournier’s gangrene and genital infections. J Urol 2007, 177:967–971.CrossRefPubMedGoogle Scholar
  40. 40.
    Laibl VR, Sheffield JS, Roberts S, et al.: Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. Obstet Gynecol 2005, 106:461–465.PubMedGoogle Scholar
  41. 41.
    Cook HA, Furuya EY, Larson E, et al.: Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2007, 44:410–413.CrossRefPubMedGoogle Scholar
  42. 42.
    Roberts JR, McCawley L, Laxton M, et al.: Genital community-associated methicillin resistant Staphylococcus aureus infection can be a sexually transmitted disease. Ann Emerg Med 2007, 50:93–94.CrossRefPubMedGoogle Scholar
  43. 43.
    Gorwitz RJ, Jernigan DB, Powers JH, et al.: Participants in the CDC Convened Experts’ Meeting on Management of MRSA in the Community: Strategies for clinical management of MRSA in the community: summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dhqp/pdf/ar/CAMRSA_ExpMtgStrategies.pdf. Accessed June 2009.
  44. 44.
    Centers for Disease Control and Prevention: Outpatient management of skin and soft tissue infections in the era of community-associated MRSA. Available at http://www.cdc.gov/ncidod/dhqp/pdf/ar/AMA_Flyer_Final.pdf. Accessed June 2009.
  45. 45.
    Rajendran PM, Young D, Maurer T, et al.: Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007, 51:4044–4048.CrossRefPubMedGoogle Scholar
  46. 46.
    Simor AE, Daneman N: Staphylococcus aureus decolonization as a prevention strategy. Infect Dis Clin North Am 2009, 23:133–151.CrossRefPubMedGoogle Scholar
  47. 47.
    Raz R, Miron D, Colodner R, et al.: A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection. Arch Intern Med 1996, 156:1109–1112.CrossRefPubMedGoogle Scholar
  48. 48.
    Ellis MW, Griffith ME, Dooley DP, et al.: Targeted intranasal mupirocin to prevent colonization and infection by community-associated methicillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial. Antimicrob Agents Chemother 2007, 51:3591–3598.CrossRefPubMedGoogle Scholar
  49. 49.
    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.CrossRefPubMedGoogle Scholar
  50. 50.
    County of Sonoma (CA), Department of Health Services, Infectious Disease Task Force: CA-MRSA treatment guidelines. Available at http://www.sonoma-county.org/health/ph/diseasecontrol/pdf/mrsa_treatment.pdf. Accessed June 2009.

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Division of Infectious DiseasesWayne State University School of MedicineDetroitUSA

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