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MRSA: Resistenzmechanismen, Epidemiologie, Risikofaktoren, Prophylaxe, Therapie

MRSA: Mechanism of resistance, epidemiology, risk factors, prophylaxis, therapy

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Methicillin-resistente Staphylococcus aureus-Stämme (MRSA) sind inzwischen in vielen Ländern verbreitete Erreger, denen eine besondere Aufmerksamkeit geschenkt wird. In der vorliegenden Übersichtsarbeit werden der Resistenzmechanismus, die Epidemiologie der Verbreitung im Krankenhaus (H-MRSA) bzw. in Einrichtungen des Gesundheitswesens (HCA-MRSA) und außerhalb des Krankenhauses (C-MRSA), Ursachen der Zunahme des Nachweises, Besiedlungsdynamik, Erkrankungsrisiko und Letalität, das Vorgehen bei MRSA-Nachweis, Methoden zur Dekolonisierung, Überwachungskulturen sowie therapeutische Optionen diskutiert.

Summary

Methicillin-resistant strains of Staphylococcus aureus (MRSA) are now widespread pathogens in many countries. The increasing number of MRSA is a challenge to clinicians and health care systems. In this review, mechanism of resistance, epidemiological patterns in hospitals (H-MRSA), health care institutions (HCA-MRSA) and in the community (C-MRSA), reasons for increase, dynamic of colonization, risk of disease and mortality, guidelines in case of detection, decolonization of patients, surveillance cultures and therapeutic options are discussed.

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References

  1. Beaujean DJ, Weersink AJ, Blok HE, Frenay HM, Verhoef J (1999) Determining risk factors for methicillin-resistant Staphylococcus aureus carriage after discharge from hospital. J Hosp Infect 42(3):213–218

    Google Scholar 

  2. Berger-Bächi B, Strassle A, Kayser FH (1989) Natural methicillin resistance in comparison with that selected by in vitro drug exposure in Staphylococcus aureus. J Antimicrob Chemother 23(2):179–188

    Google Scholar 

  3. Birmingham MC, Rayner CR, Meagher AK, Flavin SM, Batts DH, Schentag JJ (2003) Linezolid for the treatment of multidrug-resistant, gram-positive infections: experience from a compassionate-use program. Clin Infect Dis 36(2):159–168

    Google Scholar 

  4. Borer A, Gilad J, Yagupsky P, Peled N, Porat N, Trefler R, Shprecher-Levy H, Riesenberg K, Shipman M, Schlaeffer F (2002) Community-acquired methicillin-resistant Staphylococcus aureus in institutionalized adults with developmental disabilities. Emerg Infect Dis 8:966–970

    Google Scholar 

  5. Boyce JM (1997) Epidemiology and prevention of nosocomial Infections. In: Crossley KB, Archer GL (eds) The Staphylococci in human disease. Churchill Livingstone New York, Edinburgh, London, Madrid, Melbourne, San Fransisco, Tokyo

  6. Buckingham SC, McDougal LK, Cathey LD, Comeaux K, Craig AS, Fridkin SK, Tenover FC (2004) Emergence of community-associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee Children’s Hospital. Pediatr Infect Dis J 23:619–624

    Google Scholar 

  7. Chambers HF (2001) The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 7:178–182

    Google Scholar 

  8. Chang SC, Hsieh SM, Chen ML, Sheng WH, Chen YC (2000) Oral fusidic acid fails to eradicate methicillin-resistant Staphylococcus aureus colonization and results in emergence of fusidic acid-resistant strains. Diagn Microbiol Infect Dis 36:131–136

    Google Scholar 

  9. Carleton HA, Diep BA, Charlebois ED, Sensabaugh GF, Perdreau-Remington F (2004) Communityadapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis, 190:1730–1738

    Google Scholar 

  10. Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth G, Lai R, Ebrahim S (2004). BMJ 329:533–540

    Google Scholar 

  11. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y (2003) Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 36(1):53–59

    Google Scholar 

  12. Couto I, Wu SW, Tomasz A, de Lencastre H (2003) Development of Methicillin Resistance in Clinical Isolates of Staphylococcus sciuri by Transcriptional Activation of the mecA Homologue Native to the Species J Bacteriol 185:645–653

    Google Scholar 

  13. Crowcroft NS, Ronveaux O, Monnet DL, Mertens R (1999) Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol (1):31–36

    Google Scholar 

  14. Cruciani M, Gatti G, Lazzarini L, Furlan G, Broccali G, Malena M, Franchini C, Concia E (1996) Penetration of vancomycin into human lung tissue. J Antimicrob Chemother 38:865–869

    Google Scholar 

  15. Davis KA, Stewart JJ, Crouch HK, Florenz CE, Hospenthal DR (2004) Clin Infect Dis 39:776–782

    Google Scholar 

  16. Dupeyron C, Campillo B, Bordes M, Faubert E, Richardet JP, Mangeney N (2002) A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit. J Hosp Infect 52(4):281–287

    Google Scholar 

  17. Ellis MW, Hospenthal DR, Dooley DP, Gray PJ, Murray CK (2004) Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 39:971–979

    Google Scholar 

  18. Fey PD, Said-Salim B, Rupp ME, Hinrichs SH, Boxrud DJ, Davis CC, Kreiswirth BN, Schlievert PM (2003) Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 47:196–203

    Google Scholar 

  19. Gang RK, Sanyal SC, Mokaddas E, Lari AR (1999) Rifampicin as an adjunct to vancomycin therapy in MRSA septicaemia in burns. Burns 25:640–644

    Google Scholar 

  20. Garrouste-Oregas M, Timsit JF, Kallel H, Ben Ali A, Dumay MF, Paoli B et al (2001) Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 22:687–692

    Google Scholar 

  21. Gillet Y, Issartel B, Vanhems P, Fournet JC, Lina G, Bes M, Vandenesch F, Piemont Y, Brousse N, Floret D, Etienne J (2002) Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 359:753–759

    Google Scholar 

  22. Girou E, Azar J, Wolkenstein P, Cizeau F, Brun-Buisson C, Roujeau JC (2000) Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 21(9):583–587

    Google Scholar 

  23. Gould IM, Macckenzie FM, Lopez-Lozano JM, Monnet DL, Wilson R, Beyaert A (2002) Temporal Relationship between Prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) in One Hospital and Prevalence of MRSA in the Surrounding Community: A Time Series Analysis. 42nd ICAAC Abstracts, American Society for Microbiology, September 27–30, San Diego, CA, p 304

  24. Glück U, Gebbers JO (2000) The nose as bacterial reservoir: important differences between the vestibule and cavity. Laryngoscope 110:426–428

    Google Scholar 

  25. Graffunder EM, Venezia RA (2002) Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother, 49:999–1005

    Google Scholar 

  26. Groom AV, Wolsey DH, Naimi TS, Smith K, Johnson S, Boxrud D, Moore KA, Cheek JE (2001) Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 286:1201–1205

    Google Scholar 

  27. Hanssen A-M, Kjeldsen G, Sollid JUE (2004) Local variants of staphylococcal cassette chromosome mec in sporadic methicillin-resistent Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci: Evidence of horizontal gene transfer? Antimicrob Agents Chemother 48:285–296

    Google Scholar 

  28. Jarløv JO, Høiby N (1998) Coagulasenegative staphylococci in a major Danish university hospital: diversity in antibiotic susceptibility between wards. APMIS 106:411–416

    Google Scholar 

  29. Jevons MP (1961) “Celbenin-resistant” staphylococci. BMJ 1:124–125

    Google Scholar 

  30. Kang SL, Ryback MJ (1995) Pharmacodynamics of RP 59500 alone and in combination with vancomycin against Staphylococcus aureus in an in vitro-infected fibrin clot model. Antimicrob Agents Chemother 39:1505–1511

    Google Scholar 

  31. Kerttula AM, Lyytikainen O, Salmenlinna S, Vuopio-Varkila J (2004) Changing epidemiology of methicillin-resistant Staphylococcus aureus in Finland. J Hosp Infect 58:109–114

    Google Scholar 

  32. Landman D, Chockalingam M, Quale JM (1999) Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis 28:1062–1066

    Google Scholar 

  33. Löwdin E, Odenholt I, Cars O (1998) In vitro studies of pharmacodynamic properties of vancomycin against Staphylococcus aureus and Staphylococcus epidermidis. Antimicrob Agents Chemother 42:2739–2744

    Google Scholar 

  34. Maraha B, van Halteren J, Verzijl JM, Wintermans RG, Buiting AG (2002) Decolonization of methicillin-resistant Staphylococcus aureus using oral vancomycin and topical mupirocin. Clin Microbiol Infect 8:671–675

    Google Scholar 

  35. Markowitz N, Quinn EL, Saravolatz LD (1992) Trimethoprim-sulfamethoxazole compared with Vancomycin for the treatment of Staphylococcus infection. Ann Intern Med 117:390–398

    Google Scholar 

  36. Mehall JR, Kite CA, Gilliam CH, Jackson RJ, Smith SD (2002) Enteral feeding tubes are a reservoir for nosocomial antibiotic-resistant pathogens. J Pediatr Surg 37:1011–1012

    Google Scholar 

  37. Moise PA, Forrest A, Birmingham MC, Schentag JJ (2002) The efficacy and safety of linezolid as treatment for Staphylococcus aureus infections in compassionate use patients who are intolerant of, or who have failed to respond to, vancomycin. J Antimicrob Chemother 50:1017–1026

    Google Scholar 

  38. Moise-Broder PA, Forrest A, Birmingham MC, Schentag JJ (2004) Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections. Clin Pharmacokinet 43:925–942

    Google Scholar 

  39. Monnet DL, MacKenzie FM, Lopez-Lozano JM, Beyaert A, Camacho M, Wilson R, Stuart D, Gould IM (2004) Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996–2000. Emerg Infect Dis 10:1432–1441

    Google Scholar 

  40. NN (2002) Staphylococcus aureus resistant to vancomycin—United States. MMWR 51:565–567

    Google Scholar 

  41. Pfeil E, Gustafsson I, Cars O, Wiedemann B (2000) Pharmacology of Quinupristin-Dalfopristin (Q–D) with MSSA and MRSA in Comparison to Vancomycin (VAN). Abstracts of the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, p 36

  42. Pujol M, Pena C, Pallares R, Ariza J, Ayats J, Dominguez MA, Gudiol F (1996) Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 100:509–516

    Google Scholar 

  43. Roghmann MC, Siddiqui A, Plaisance K, Standiford H (2001) MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect 47:98–103

    Google Scholar 

  44. Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC, Eliopoulos GM (2004) Relationship of MIC and bactericidal activity to efficacy of Vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 42:2398–2402

    Google Scholar 

  45. Schmitz F-J, Petridou J, Fluit AC, Hadding U, Peters G, von Eiff C (2000) Distribution of macrolide-resistance genes in Staphylococcus aureus blood-culture isolates from fifteen German university hospitals. M.A.R.S. Study Group. Multicentre Study on Antibiotic Resistance in Staphylococci. Eur J Clin Microbiol Infect Dis 19:385–387

    Google Scholar 

  46. Shinefield H, Black S, Fattom A, Horwith G, Rasgon S, Ordonez J, Yeoh H, Law D, Robbins JB, Schneerson R, Muenz L, Fuller S, Johnson J, Fireman B, Alcorn H, Naso R (2002) Use of a Staphylococcus aureus conjugate vaccine in patients receiving hemodialysis. N Engl J Med 346:491–496

    Google Scholar 

  47. Silvestri L, Milanese M, Oblach L, Fontana F, Gregori D, Guerra R, van Saene HK (2002) Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients. Am J Infect Control 30:391–399

    Google Scholar 

  48. Sloot N, Siebert J, Hoffler U (1999) Eradication of MRSA from carriers by means of whole-body washing with an antiseptic in combination with mupirocin nasal ointment. Zentralbl Hyg Umweltmed 202:513–523

    Google Scholar 

  49. Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B (2002) Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis 34:1481–1490

    Google Scholar 

  50. Talon DR, Bertrand X (2001) Methicillin-resistant Staphylococcus aureus in geriatric patients: usefulness of screening in a chronic-care setting. Infect Control Hosp Epidemiol 22:505–509

    Google Scholar 

  51. Viale P, Pagani L, Cristini F, Stefini R, Bergomi R, Colombini P, Carosi G (2002) Linezolid for the treatment of central nervous system infections in neurosurgical patients. Scand J Infect Dis 34:456–459

    Google Scholar 

  52. Villani P, Regazzi MB, Marubbi F, Viale P, Pagani L, Cristini F, Cadeo B, Carosi G, Bergomi R (2002) Cerebrospinal fluid linezolid concentrations in postneurosurgical central nervous system infections. Antimicrob Agents Chemother 46:936–937

    Google Scholar 

  53. von Eiff C, Becker K, Machka K, Stammer H, Peters G (2001) Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 344:11–16

    Google Scholar 

  54. Vriens M, Blok H, Fluit A, Troelstra A, Van Der Werken C, Verhoef J (2002) Costs Associated with a Strict Policy to Eradicate Methicillin-Resistant Staphylococcus aureus in a Dutch University Medical Center: A 10-Year Survey. Eur J Clin Microbiol Infect Dis 21:782–786

    Google Scholar 

  55. Wannet WJ, Spalburg E, Heck ME, Pluister GN, Willems RJ, De Neeling AJ (2004) Widespread dissemination in The Netherlands of the epidemic berlin methicillin-resistant Staphylococcus aureus clone with low-level resistance to oxacillin. J Clin Microbiol 42:3077–3082

    Google Scholar 

  56. Washio M, Kiyohara C, Arai Y, Aoyagi K, Okada K, Fujishima M, Maeda M, Ito Y (1998) Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa isolation from pharyngeal swab cultures among the Japanese elderly at admission to a geriatric hospital. Public Health 112:415–417

    Google Scholar 

  57. Willke RJ, Glick HA, Li JZ, Rittenhouse BE (2002) Effects of linezolid on hospital length of stay compared with vancomycin in treatment of methicillin-resistant Staphylococcus infections. An application of multivariate survival analysis. Int J Technol Assess Health Care 18:540–554

    Google Scholar 

  58. Young DM, Harris HW, Charlebois ED, Chambers H, Campbell A, Perdreau-Remington F, Lee C, Mankani M, Mackersie R, Schecter WP (2004) An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients. Arch Surg 139:947–951

    Google Scholar 

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  1. Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin

    P. Heizmann &  R. Hetzer

  2. Zentrum für Mikrobiologie und Infektiologie, Berlin

    W. R. Heizmann

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Heizmann, P., Heizmann, W.R. & Hetzer, R. MRSA: Resistenzmechanismen, Epidemiologie, Risikofaktoren, Prophylaxe, Therapie. Z Herz- Thorax- Gefäßchir 19, 78–88 (2005). https://doi.org/10.1007/s00398-005-0486-0

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