Skip to main content
SpringerLink
Log in

Praktische Konsequenzen durch den Nachweis von MRSA in chronischen Wunden

Practical consequences after MRSA identification in chronic wounds

  • Leitthema
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

In den letzten Jahren wird zunehmend über eine Häufung von dermatologischen Patienten mit chronischen Wunden und dem Nachweis von sog. Problemkeimen wie dem Methicillin-resistenten Staphylococcus aureus (MRSA) berichtet. Auch wenn bislang nicht eindeutig geklärt werden konnte, ob die bakterielle Kontamination mit MRSA tatsächlich einen die Wundheilung verzögernden eigenständigen Effekt hat, sind sowohl die logistischen als auch therapeutischen Konsequenzen, die sich aus dem Nachweis von MRSA ergeben, für den Patienten und die behandelnde medizinische Institution erheblich. In diesem Übersichtsbeitrag werden die praktischen Konsequenzen und insbesondere die Therapieoptionen, die bei dem Nachweis von MRSA bei Patienten mit chronischen Wunden sinnvoll sind, dargestellt.

Abstract

In the last years increasing of numbers dermatologic patients with chronic wounds and problem bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) have been reported. Even though it is still unclear if bacterial contamination with MRSA independently interferes with wound healing, both the logistic and therapeutic consequences of identifying MRSA are considerable for the patient and the treatment facility. In this review the practical consequences and the therapy options associated with the identification of MRSA in patients with chronic wounds are considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Anonymous (1999) Empfehlung zur Prävention von Methicilin-resistenten Staphylococcus aureus Stämmen (MRSA) in Krankenhäusern und anderen medizinischen Einrichtungen. Bundesgesundheitsblatt 12: 954–958

    Google Scholar 

  2. Bonn D (2000) Maggot therapy: an alternative for wound infection. Lancet 356: 1174

    Article  PubMed  CAS  Google Scholar 

  3. CDC (2002) Staphylococcus aureus resistant to vancomycin-United States 2002. MMWR Morb Mortal Wkly Rep 51: 565–567

    Google Scholar 

  4. Colsky AS, Kirsner RS, Kerdel FA (1998) Analysis of antibiotic susceptibilities of wound flora in hospitalised dermatology patients: the crisis of antibiotic resistance has come to the surface. Arch Dermatol 134: 1006–1009

    Article  PubMed  CAS  Google Scholar 

  5. Cosgrove SE, Sakoulas G, Perencevich EN et al. (2003) Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 36: 53–59

    Article  PubMed  Google Scholar 

  6. d’Audiffret A, Roethle S, Tretinyak A, Santilli S (2002) Use of a non-contact radiant heat bandage on ischemic dermal infections in an ovine model. Med Sci Monit 8:289–292

    Google Scholar 

  7. Dissemond J, Geisheimer M, Goos M (2004) Eradikation eines ORSA bei einem Patienten mit Ulcus cruris durch Lavasept-Gel. ZfW 1: 29–32

    Google Scholar 

  8. Dissemond J, Koppermann M, Esser S et al. (2002) Therapie eines Methicillin-resistenten Staphylokokkus aureus (MRSA) im Rahmen der Behandlung eines chronischen Ulcus mittels Biochirurgie. Hautarzt 53: 608–612

    Article  PubMed  CAS  Google Scholar 

  9. Dissemond J, Körber A, Lehnen M, Grabbe S (2005) Methicillin resistenter Staphylococcus aureus (MRSA) in chronischen Wunden: Therapeutische Optionen und Perspektiven. J Dtsch Dermatol Ges 3: 256–262

    Article  PubMed  Google Scholar 

  10. Dissemond J, Schmid EN, Esser S et al. (2004) Untersuchungen zur bakteriellen Kolonisation chronischer Wunden in einer universitären dermatologischen Wundambulanz unter besonderer Berücksichtigung von ORSA. Hautarzt 55: 280–288

    Article  PubMed  CAS  Google Scholar 

  11. Ellis SL, Finn P, Noone M, Leaper DJ (2003) Eradication of methicillin-resistant Staphylococcus aureus from pressure sores using warming therapy. Surg Infect 4: 53–55

    Article  Google Scholar 

  12. Filius PM, Gyssens IC (2002) Impact of increasing antimicrobial resistance on wound management. Am J Clin Dermatol 3: 1–7

    Article  PubMed  Google Scholar 

  13. Flemming K, Cullum N (2000) Therapeutic ultrasound for venous leg ulcers. Cochrane Database Syst Rev 4: 1180

    Google Scholar 

  14. Fridkin SK, Hageman JC, Morrison M et al. (2005) Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 352: 1436–1444

    Article  PubMed  CAS  Google Scholar 

  15. Gillet Y, Issartel B, Vanhems P et al. (2002) Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2(359): 753–759

    Article  Google Scholar 

  16. Grohs P, Kitzis MD, Gutmann L (2003) In vitro bactercidal activities of linezolid in combination with vancomycin, gentamycin, ciprofloxacin, fusidic acid, and rifampin against staphylococcus aureus. Antimicrob Agents Chemother 47: 418–420

    Article  PubMed  CAS  Google Scholar 

  17. Harbarth S, Dharan S, Liassine N et al. (1999) Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 43: 1412–1416

    PubMed  CAS  Google Scholar 

  18. Hiramatsu K (2001) Vancomycin-resistant Staphylococcus aureus: a new model of antibiotic resistance. Lancet Infect Dis 1: 147–155

    Article  PubMed  CAS  Google Scholar 

  19. Hon KL, Lam MC, Leung TF et al. (2005) Clinical features associated with nasal Staphylococcus aureus colonisation in Chinese children with moderate-to-severe atopic dermatitis. Ann Acad Med Singapore 34: 602–605

    PubMed  CAS  Google Scholar 

  20. Jappe U, Petzoldt D, Wendt C (2004) Methicillin-resistant Staphylococcus aureus colonization in inflammatory versus non-inflammatory skin diseases: who should be screened? Acta Derm Venereol 84: 181–186

    Article  PubMed  Google Scholar 

  21. Jasir A, Kasprzykowski F, Lindstrom V et al. (2004) New antimicrobial peptide active against Gram-positive pathogens. Indian J Med Res 119: 74–76

    PubMed  CAS  Google Scholar 

  22. Kac G, Buu-Hoi A, Herisson E et al. (2000) Methicillin-resistent staphylococcus aureus. Nosocomial acquisition and carrier state in a wound care center. Arch Dermatol 136: 735–739

    Article  PubMed  CAS  Google Scholar 

  23. Knighton DR, Fiegel VD, Halverson T et al. (1990) Oxygen as an antibiotic. The effect of inspired oxygen on bacterial clearance. Arch Sur 125: 97–100

    CAS  Google Scholar 

  24. Krasagakis K, Samonis G, Maniatakis P et al. (2006) Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology 212: 31–35

    Article  PubMed  CAS  Google Scholar 

  25. Leszczynski P, Weber-Dabrowska B, Kohutnicka M et al. (2006) Successful eradication of methicillin-resistant Staphylococcus aureus (MRSA) intestinal carrier status in a healthcare worker – a case report. Folia Microbiol 51: 236–238

    Article  CAS  Google Scholar 

  26. Linde HJ, Lehn N (2002) Methicillin-resistenter Staphylococcus aureus (MRSA). Hautarzt 53: 690–701

    Article  Google Scholar 

  27. Mertz PM, Oliveira-Gandia MF, Davis SC (1999) The evaluation of a cadoxomer iodine wound dressing on methicillin resistant staphylococcus aureus (MRSA) in acute wounds. Dermatol Surg 25: 89–93

    Article  PubMed  CAS  Google Scholar 

  28. Natarajan S, Williamson D, Grey J et al. (2001) Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey. J Dermatolog Treat 12: 33–36

    Article  PubMed  CAS  Google Scholar 

  29. O’Meara S, Cullum N, Majid M, Sheldon T (2000) Systemic review of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health Technol Assessment 4: 1–237

    Google Scholar 

  30. Ohwada A, Sekiya M, Hanaki H et al. (1999) DNA vaccination by mecA sequence evokes an antibacterial immune response against methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 44: 767–774

    Article  PubMed  CAS  Google Scholar 

  31. Okano M, Nagouchi S, Tabata K, Matsumoto Y (2000) Topical gentian violet for cutaneous infection and nasal carriage with MRSA. Int J Dermatol 39: 942–944

    Article  PubMed  CAS  Google Scholar 

  32. Paladino JA (2002) Linezolid: an oxazolidinone antimicrobial agent. Am J Health Syst Pharm 59: 2413–2425

    PubMed  CAS  Google Scholar 

  33. Patil R, Baveja S, Nataraj G, Khopkar U (2006) Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma. Indian J Dermatol Venereol Leprol 72: 126–128

    Article  PubMed  Google Scholar 

  34. Robbins JB, Schneerson R, Horwith G et al. (2004) Staphylococcus aureus types 5 and 8 capsular polysaccharide-protein conjugate vaccines. Am Heart J 147: 593–598

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  36. Spangler D, Rothenburger S, Nguyen K et al. (2003) In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect 4: 255–262

    Article  Google Scholar 

  37. Stone GW, Zhang Q, Castillo R et al. (2004) Mechanism of action of NB2001 and NB2030, novel antibacterial agents activated by beta-lactamases. Antimicrob Agents Chemother 48: 477–483

    Article  PubMed  CAS  Google Scholar 

  38. Stone LL, Dalton HP, Haynes BW (1980) Bacterial debridement of the burn eschar: the in vivo activity of selected organisms. J Surg Res 29: 83–92

    Article  PubMed  CAS  Google Scholar 

  39. Thai TP, Houghton PE, Campell KE, Wodbury MG (2002) Ultraviolet light C in the treatment of chronic wounds with MRSA: a case study. Ostomy Wound Management 48: 52–60

    Google Scholar 

  40. Valencia IC, Kirsner RS, Kerdel FA (2004) Microbiologic evaluation of skin wounds: alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period. J Am Acad Dermatol 50: 845–849

    Article  PubMed  Google Scholar 

  41. von Eiff C, Peters G (1999) Comparative in-vitro activities of moxifloxacin, trovafloxacin, quinupristin/dalfopristin and linezolid against staphylococci. J Antimicrobial Chemother 43: 569–573

    Article  Google Scholar 

  42. Voss A, Milatovic D, Wallrauch-Schwarz C et al. (1994) Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 13: 50–55

    Article  PubMed  CAS  Google Scholar 

  43. Whitby M, McLaws ML, Berry G (2001) Risk of death from methicillin-resistant staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 175: 264–267

    PubMed  CAS  Google Scholar 

  44. Witte W, Wiese-Posselt M, Jappe U (2005) Community MRSA – Eine neue Herausforderung für die Dermatologie. Hautarzt 56: 731–738

    Article  PubMed  CAS  Google Scholar 

  45. Wright JB, Lam K, Burrell RE (1998) Wound management in an era of increasing bacterial antibiotic resistance: a role for topical silver treatment. Am J Infect Control 26: 572–577

    Article  PubMed  CAS  Google Scholar 

  46. Zeina B, Greenman J, Purcell WM, Das B (2001) Killing of cutaneous microbial species by photodynamic therapy. Br J Dermatol 144: 274–278

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    J. Dissemond

Authors
  1. J. Dissemond
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Dissemond.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dissemond, J. Praktische Konsequenzen durch den Nachweis von MRSA in chronischen Wunden. Hautarzt 58, 952–958 (2007). https://doi.org/10.1007/s00105-007-1403-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-007-1403-0

Schlüsselwörter

Keywords

Search

Navigation