, Volume 36, Issue 6, pp 590–592

Complicated Community-Acquired Soft Tissue Infection by MRSA from Porcine Origin

Case Report


Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of community acquired soft tissue infection in Europe. We report a case of severe soft tissue infection caused by a MRSA strain originating from a pig bite.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hsueh PR, Chen WH, Luh KT: Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991–2003 at a university hospital in Taiwan. Int J Antimicrob Agents 2005; 26: 463–472.PubMedCrossRefGoogle Scholar
  2. 2.
    Paterson DL: “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 2004; 38: S341–S345.PubMedCrossRefGoogle Scholar
  3. 3.
    Albrich WC, Monnet DL, Harbarth S: Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerg Infect Dis 2004; 10: 514–517.PubMedGoogle Scholar
  4. 4.
    Goossens H, Ferech M, Vander Stichele R, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365: 579–587.PubMedGoogle Scholar
  5. 5.
    Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H: Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebocontrolled study. Lancet 2007; 369: 482–490.PubMedCrossRefGoogle Scholar
  6. 6.
    de With K, Bergner J, Buhner R, Dorje F, Gonnermann C, Haber M, Hartmann M, Rothe U, Strehl E, Steib-Bauert M, Kern WV: Antibiotic use in German university hospitals 1998–2000 (Project INTERUNI-II). Int J Antimicrob Agents 2004; 24: 213–218.PubMedCrossRefGoogle Scholar
  7. 7.
    Janknegt R, Oude Lashof A, Gould IM, van der Meer JW: Antibiotic use in Dutch hospitals 1991–1996. J Antimicrob Chemother 2000; 45: 251–256.PubMedCrossRefGoogle Scholar
  8. 8.
    Lodise TP, McKinnon PS: Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2005; 52: 113–122.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee NY, Lee HC, Ko NY, Chang CM, Shih HI, Wu CJ, Ko WC: Clinical and economic impact of multidrug resistance in nosocomial Acinetobacter baumannii bacteremia. Infect Control Hosp Epidemiol 2007; 28: 713–719.PubMedCrossRefGoogle Scholar
  10. 10.
    WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2007. Oslo, 2006. Available at: Accessed 9 September 2007.
  11. 11.
    Platt R: Toward better benchmarking. Infect Control Hosp Epidemiol 2005; 26: 433–434.PubMedCrossRefGoogle Scholar
  12. 12.
    Westh H: Benchmarking. In: Gould IM, Meer JWM van der (eds): Antibiotic policies. Theory and practice. Kluwer Academic, New York 2005, pp 119–132.CrossRefGoogle Scholar
  13. 13.
    Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C: Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007; 44: 664–670.PubMedCrossRefGoogle Scholar
  14. 14.
    Kern WV, Steib-Bauert M, de With K, Reuter S, Bertz H, Frank U, von Baum H: Fluoroquinolone consumption and resistance in haematology-oncology patients: ecological analysis in two university hospitals 1999–2002. J Antimicrob Chemother 2005; 55: 57–60.PubMedCrossRefGoogle Scholar
  15. 15.
    Kern WV, de With K, Steib-Bauert M, Fellhauer M, Plangger A, Probst W: Antibiotic use in non-university regional acute care general hospitals in southwestern Germany, 2001–2002. Infection 2005; 33: 333–339.PubMedCrossRefGoogle Scholar
  16. 16.
    de With K, Maier L, Steib-Bauert M, Kern P, Kern WV: Trends in antibiotic use at a university hospital: defined or prescribed daily doses? Patient days or admissions as denominator? Infection 2006; 34: 91–94.PubMedCrossRefGoogle Scholar
  17. 17.
    Kritsotakis EI, Gikas A: Surveillance of antibiotic use in hospitals: methods, trends and targets. Clin Microbiol Infect 2006; 12: 701–704.PubMedGoogle Scholar
  18. 18.
    Keenan SP, Dodek P, Martin C, Priestap F, Norena M, Wong H: Variation in length of intensive care unit stay after cardiac arrest: where you are is as important as who you are. Crit Care Med 2007; 35: 836–841.PubMedCrossRefGoogle Scholar
  19. 19.
    DeFrances CJ, Hall MJ: National hospital discharge survey. Adv Data 2005; 2007: 1–19.Google Scholar
  20. 20.
    Westert GP, Lagoe RJ, Keskimaki I, Leyland A, Murphy M: An international study of hospital readmissions and related utilization in Europe and the USA. Health Policy 2002; 61: 269–278.PubMedCrossRefGoogle Scholar
  21. 21.
    Theurl E, Winner H: The impact of hospital financing on the length of stay: evidence from Austria. Health Policy 2007; 82: 375–389.PubMedCrossRefGoogle Scholar
  22. 22.
    Esposito S, Noviello S, Leone S, Tice A, Seibold G, Nathwani D, Scaglione F: Outpatient parenteral antibiotic therapy (OPAT) in different countries: a comparison. Int J Antimicrob Agents 2004; 24: 473–478.PubMedCrossRefGoogle Scholar
  23. 23.
    Monnet DL: ABC Calc — Antibiotic consumption calculator [Microsoft Excel application]. Version 3.0. Statens Serum Institute, Copenhagen, 2005.Google Scholar
  24. 24.
    Loeffler JM, Garbino J, Lew D, Harbarth S, Rohner P: Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units. Scand J Infect Dis 2003; 35: 843–850.PubMedCrossRefGoogle Scholar
  25. 25.
    Ruttimann S, Keck B, Hartmeier C, Maetzel A, Bucher HC: Longterm antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clin Infect Dis 2004; 38: 348–356.PubMedCrossRefGoogle Scholar
  26. 26.
    Mach R, Vlcek J, Prusova M, Batka P, Rysavy V, Kubena A: Impact of a multidisciplinary approach on antibiotic consumption, cost and microbial resistance in a Czech hospital. Pharm World Sci 2007; 29: 565–572.PubMedCrossRefGoogle Scholar
  27. 27.
    Muller-Pebody B, Muscat M, Pelle B, Klein BM, Brandt CT, Monnet DL: Increase and change in pattern of hospital antimicrobial use, Denmark, 1997–2001. J Antimicrob Chemother 2004; 54: 1122–1126.PubMedCrossRefGoogle Scholar
  28. 28.
    DANMAP: Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, foods and humans in Denmark. 2006. ISSN 1600–2032.Google Scholar
  29. 29.
    Naaber P, Koljalg S, Maimets M: Antibiotic usage and resistance - trends in Estonian University Hospitals. Int J Antimicrob Agents 2000; 16: 309–315.PubMedCrossRefGoogle Scholar
  30. 30.
    Muller A, Monnet DL, Talon D, Henon T, Bertrand X: Discrepancies between prescribed daily doses and WHO defined daily doses of antibacterials at a university hospital. Br J Clin Pharmacol 2006; 61: 585–591.PubMedCrossRefGoogle Scholar
  31. 31.
    Rogues AM, Placet-Thomazeau B, Parneix P, Vincent I, Ploy MC, Marty N, Merillou B, Labadie JC, Gachie JP: Use of antibiotics in hospitals in south-western France. J Hosp Infect 2004; 58: 187–192.PubMedCrossRefGoogle Scholar
  32. 32.
    de With K, Steib-Bauert M, Straach P, Kern WV: Is there significant regional variation in hospital antibiotic consumption in Germany? Infection 2006; 34: 274–277.PubMedCrossRefGoogle Scholar
  33. 33.
    de With K, Meyer E, Steib-Bauert M, Schwab F, Daschner FD, Kern WV: Antibiotic use in two cohorts of German intensive care units. J Hosp Infect 2006; 64: 231–237.PubMedCrossRefGoogle Scholar
  34. 34.
    Bassetti M, Di Biagio A, Rebesco B, Amalfitano ME, Topal J, Bassetti D: The effect of formulary restriction in the use of antibiotics in an Italian hospital. Eur J Clin Pharmacol 2001; 57: 529–534.PubMedCrossRefGoogle Scholar
  35. 35.
    Blix HS, Hartug S: Hospital usage of antibacterial agents in relation to size and type of hospital and geographical situation. Pharmacoepidemiol Drug Saf 2005; 14: 647–649.PubMedCrossRefGoogle Scholar
  36. 36.
    Goryachkina K, Babak S, Burbello A, Wettemark B, Bergman U: Quality use of medicines: a new method of combining antibiotic consumption and sensitivity data-application in a Russian hospital. Pharmacoepidemiol Drug Saf 2008; 17: 636–644.PubMedCrossRefGoogle Scholar
  37. 37.
    Hermosilla Najera L, Canut Blasco A, Ulibarrena Sanz M, Abasolo Osinaga E, Abecia Inchaurregui LC: Trends in antimicrobial utilization at a Spanish general hospital during a 5-year period. Pharmacoepidemiol Drug Saf 2003; 12: 243–247.PubMedCrossRefGoogle Scholar
  38. 38.
    Walther SM, Erlandsson M, Burman LG, Cars O, Gill H, Hoffman M, Isaksson B, Kahlmeter G, Lindgren S, Nilsson L, Olsson-Liljequist B, Hanberger H: Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units. Acta Anaesthesiol Scand 2002; 46: 1075–1081.PubMedCrossRefGoogle Scholar
  39. 39.
    Bergman U, Risinggard H, Vlahovic-Palcevski V, Ericsson O: Use of antibiotics at hospitals in Stockholm: a benchmarking project using internet. Pharmacoepidemiol Drug Saf 2004; 13: 465–471.PubMedCrossRefGoogle Scholar
  40. 40.
    SWEDRES: A report on Swedish antibiotic utilisation and resistance in human medicine 2006. ISSN 1400–3473.Google Scholar
  41. 41.
    Liem TB, Filius FM, van der Linden PD, Janknegt R, Natsch S, Vulto AG: Changes in antibiotic use in Dutch hospitals over a six-year period: 1997 to 2002. Neth J Med 2005; 63: 354–360.PubMedGoogle Scholar
  42. 42.
    Filius PM, Liem TB, van der Linden PD, Janknegt R, Natsch S, Vulto AG, Verbrugh HA: An additional measure for quantifying antibiotic use in hospitals. J Antimicrob Chemother 2005; 55: 805–808.PubMedCrossRefGoogle Scholar
  43. 43.
    SWAB: NethMap 2007 — consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in The Netherlands.Google Scholar
  44. 44.
    Curtis C, Marriott J, Langley C: Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care. J Antimicrob Chemother 2004; 54: 529–533.PubMedCrossRefGoogle Scholar
  45. 45.
    Dancer SJ, Coyne M, Robertson C, Thomson A, Guleri A, Alcock S: Antibiotic use is associated with resistance of environmental organisms in a teaching hospital. J Hosp Infect 2006; 62: 200–206.PubMedCrossRefGoogle Scholar
  46. 46.
    Vander Stichele RH, Elseviers MM, Ferech M, Blot S, Goossens H: Hospital consumption of antibiotics in 15 European countries: results of the ESAC retrospective data collection (1997–2002). J Antimicrob Chemother 2006; 58: 159–167.PubMedCrossRefGoogle Scholar
  47. 47.
    MacKenzie FM, Monnet DL, Gould IM: Relationship between the number of different antibiotics used and the total use of antibiotics in European hospitals. J Antimicrob Chemother 2006; 58: 657–660.PubMedCrossRefGoogle Scholar
  48. 48.
    Ansari F: Utilization review of systemic antiinfective agents in a teaching hospital in Tehran, Iran. Eur J Clin Pharmacol 2001; 57: 541–546.PubMedCrossRefGoogle Scholar
  49. 49.
    Apisarnthanarak A, Danchaivijitr S, Khawcharoenporn T, Limsrivilai J, Warachan B, Bailey TC, Fraser VJ: Effectiveness of education and an antibiotic-control program in a tertiary care hospital in Thailand. Clin Infect Dis 2006; 42: 768–775.PubMedCrossRefGoogle Scholar
  50. 50.
    Bantar C, Sartori B, Vesco E, Heft C, Saul M, Salamone F, Oliva ME: A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis 2003; 37: 180–186.PubMedCrossRefGoogle Scholar
  51. 51.
    Berild D, Ringertz SH, Lelek M, Fosse B: Antibiotic guidelines lead to reductions in the use and cost of antibiotics in a university hospital. Scand J Infect Dis 2001; 33: 63–67.PubMedCrossRefGoogle Scholar
  52. 52.
    Kritsotakis EI, Assithianakis P, Kanellos P, Tzagarakis N, Ioannides MC, Gikas A: Surveillance of monthly antimicrobial consumption rates stratified by patient-care area: a tool for triggering and targeting antibiotic policy changes in the hospital. J Chemother 2006; 18: 394–401.PubMedGoogle Scholar
  53. 53.
    White RL, Friedrich LV, Mihm LB, Bosso JA: Assessment of the relationship between antimicrobial usage and susceptibility: differences between the hospital and specific patient-care areas. Clin Infect Dis 2000; 31: 16–23.PubMedCrossRefGoogle Scholar
  54. 54.
    Ronning M, Blix HS, Strom H, Skovlund E, Andersen M, Stichele RV: Problems in collecting comparable national drug use data in Europe: the example of antibacterials. Eur J Clin Pharmacol 2003; 58: 843–849.PubMedGoogle Scholar
  55. 55.
    Monnet DL: Measuring antimicrobial use: the way forward. Clin Infect Dis 2007; 44: 671–673.PubMedCrossRefGoogle Scholar
  56. 56.
    Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM: Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44: 159–177.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Dept. of MicrobiologySt. JozefskliniekIzegemBelgium
  2. 2.Dept. of Orthopedic SurgerySt. JozefskliniekIzegemBelgium
  3. 3.Dept. of MicrobiologyAZ St. JanBruggeBelgium
  4. 4.Dept. of Medical Microbiology and Infectious DiseasesCanisius-Wilhelmina HospitalNijmegenThe Netherlands

Personalised recommendations