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9 : Community-Associated Methicillin-Resistant

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Abstract:

In the past decade, the view of methicillin-resistant (MRSA) epidemiology has changed. A large burden of community associated MRSA (CA-MRSA) disease was reported by prison and jail systems in California, Texas, Mississippi, and Georgia. Outbreaks have provided incentives to examine the epidemiology of CA-MRSA in closer detail. Importantly, these increases were directly translated into similar increases in the overall burden of disease. Important genetic phenomena are believed to be responsible for the phenotypic differences observed in comparisons of CA-MRSA and hospital-associated MRSA (HA-MRSA) isolates. A survey of 16 toxin genes known to be present in genomically sequenced strains revealed that important differences can be identified when HA-MRSA and CA-MRSA isolates are compared. Six exotoxin genes were found significantly more often among CA-MRSA isolates, and seven were found significantly more often among HA-MRSA strains. Asymptomatic colonization is the most frequent outcome of host interaction with . The mainstay of treatment for skin abscesses is incision and drainage of the lesion. The pneumonia may be classified as ‘’necrotizing’’ if the chest CT shows a consolidative infiltrate, destruction of normal lung architecture, and loss of tissue enhancement. The CA-MRSA epidemic has complicated the selection of empirical antibiotic therapy for presumed infections. Distinguishing HA-MRSA from CA-MRSA is useful in defining the changing epidemiology, identifying those at risk, and choosing empirical antibiotic therapy when required.

Citation: Crawford S, Boyle-Vavra S, Daum R. 2007. Community-Associated Methicillin-Resistant, p 153-179. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch9
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Image of Figure 1.
Figure 1.

(A) A 2-year-old child with a history of asthma presented to the hospital with tachypnea and fever. The chest X-ray shown here showed patchy airspace disease in the left base, interpreted to be patchy atalectasis associated with asthma. (B) Less than 24 h later, the child’s condition had rapidly deteriorated. This chest X-ray shows bilateral airspace opacification of both lungs. MRSA was isolated from the airway of this child and from the lungs at postmortem examination.

Citation: Crawford S, Boyle-Vavra S, Daum R. 2007. Community-Associated Methicillin-Resistant, p 153-179. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch9
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Image of Figure 2.
Figure 2.

(A) Chest CT of an 8-year-old boy, 1 week after he presented to the hospital with MRSA necrotizing pneumonia. This CT shows extensive opacification and ground-glass appearance of both lungs and multiple pneumatoceles, all due to severe necrotizing pneumonia. (B) Chest CT of the same patient 6 weeks later, showing extensive destruction of normal lung architecture and an anterior pneumothorax. (C) Chest radiograph of the same patient 2 months after presentation, when the patient had recovered from his acute illness. This radiograph shows patchy airspace opacities and numerous pneumatoceles bilaterally.

Citation: Crawford S, Boyle-Vavra S, Daum R. 2007. Community-Associated Methicillin-Resistant, p 153-179. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch9
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Image of Figure 3.
Figure 3.

Paradigm for management of patients with CA-MRSA skin and soft tissue infections. The designations mild, moderate, and severe refer to the levels of clinical acuity.

Citation: Crawford S, Boyle-Vavra S, Daum R. 2007. Community-Associated Methicillin-Resistant, p 153-179. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch9
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Image of Figure 4.
Figure 4.

A “D test” is performed on isolates that are resistant to erythromycin but susceptible to clindamycin in order to evaluate the potential for treatment failure when using clindamycin. Blunting of the clindamycin zone of inhibition (marked by a vertical arrow) indicates the presence of an gene in the test isolate that is inducible by erythromycin.

Citation: Crawford S, Boyle-Vavra S, Daum R. 2007. Community-Associated Methicillin-Resistant, p 153-179. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch9
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Tables

Generic image for table
Table 1.

Classification scheme of elements

Citation: Crawford S, Boyle-Vavra S, Daum R. 2007. Community-Associated Methicillin-Resistant, p 153-179. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch9

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