Disease Information for Methicillin resistant staph aureus/MRSA

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Clinical Manifestations
Signs & Symptoms
Hospital staff/secondary cases
Fever and Rash
Clinical Presentation & Variations
Fever in Immune Compromised
Fever in Neutropenia
Athletes Skin Infections
Demographics & Risk Factors
Exposure Factors
Exposure/Contaminated medical equipment/needles
Exposure/Dog vector/reservoir
Travel, Geographic & Climate Related Factors
Residence/travel/Iceland
Residence/travel/Spain
Established Disease Population
Patient/Antibiotic/broad-spectrum treatment
Patient/Intravenous drug/recreational
Patient/Recent antibiotic treatment
Population Group
Population/Hospital patient
Status/Institutionalized patient
Occupational Factors
Occupation/Health care worker
Laboratory Tests
Microbiology & Serology Findings
Microlab/Cutaneous ulcer/lesion culture abnormal
Microlab/Gram positive bacteria
Diagnostic Test Results
X-RAY
Xray/Multiple cavitary lesions of lungs/Chest
Associated Diseases & Rule outs
Rule Outs
Acne vulgaris (acne)
Anthrax
Insect Bites
Associated Disease & Complications
Furunculosis
Lymphadenitis
Lymphangitis
Methicillin resistant staphylococcus aureus/MRSA
Nosocomial infection
Pneumonia, recurrent
Pneumonia, staphylococcus
Pneumonia/Bronchopneumonia
Staphylococcus aureus infection
Staphylococcus sepsis
Acute Lymphangitis
Pyogenic Hip Arthritis
Multiple Abscesses
Disease Mechanism & Classification
Specific Agent
AGENT/Antibiotic/multiple resistant bacteria (ex)
AGENT/Bacteria (category)
AGENT/Bacteria beta lactamase producers (ex)
AGENT/Nosocomial infection/Hospital acquired (ex).
AGENT/Hospital/nosocomial pneumonia (ex)
Pathophysiology
Pathophysiology/Abscess tendency
Pathophysiology/Infection resistant to usual treatments
Treatment
Drug Therapy - Indication
RX/Antibiotic/Combinations
RX/Daptomycin (Cidecin) (restricted)
RX/Doxycycline
RX/Fusidic acid (Fusidin)
RX/Gentamycin (Garamycin)
RX/Levofloxacin (Levaquin)
RX/Linezolid (Zyvox) (RESTRICTED)
RX/Rifampin (Rifadin)
RX/Sparfloxacin (Zagam)
RX/Teicoplanin antibiotic
RX/Tigecycline (Tygacil)
RX/Trimethoprim-sulfamethoxazole (Bactrim)
RX/Vancomycin (Vancocin)
Other Treatments
TX/Infection/isolation/quarantine
Definition

The clinical presentation of MRSA depends on the site of infection; Staphylococcus aureus infections include skin and skin structure infections (furuncles, carbuncles), invasive soft tissue infections (acute osteomyelitis, myositis, pyomyositis), as well as wound infections, septicemia, pneumonia, and acute bacterial endocarditis

Though usually due to multiple organisms, several cases of necrotizing fasciitis due solely to CA-MRSA were reported in California; Painful red papules or necrotic lesions on the skin at any site, but often in areas subjected to friction or minor trauma such as the anterior thigh, buttock, groin, axilla, and waist [furuncles, carbuncles, folliculitis, pyoderm, abscess]; Patient or caregiver may suspect or report spider bites ;Cellulitis is present in 50-70% of patients with recurrent furuncles (furunculosis)

Carbuncles are painful clusters of infected follicles generally found on the back of the neck and trunk, lateral aspect of thighs ; Systemic symptoms (fever, malaise, chills) are generally absent in patients presenting with abscesses, but present with carbuncles; Invasive soft tissue and bone infections; Pyomyositis presents with symptoms of pain and swelling at the site of the muscle abscess; Acute osteomyelitis due to hematogenous spread of S aureus presents with a high fever, local edema, erythema and tenderness, fatigue, irritability, and malaise in children >4 years, adolescents, and adults; (Isolates from Enterobacter spp and group A and B Streptococcus are frequently implicated in neonatal acute osteomyelitis)

Necrotizing fasciitis may present with innocuous and nonspecific signs of red patches of skin, high fever, and chills; Pain, often disproportionate to physical signs, is characteristic; Anesthesia of involved skin, caused by damage to nerve fibers during the necrotic process, is an occasional but characteristic symptom; For Class 1 skin and soft tissues warm compresses and/or incision and drainage may be sufficient, unless there is an increased suspicion based on one or more MRSA risk factors; In such cases empiric therapy with oral antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, linezolid, or doxycycline is appropriate, adjusting the antibiotic regimen based on results of bacterial culture

Class 2 patients with more than one MRSA risk factor may also be managed with outpatient empiric therapy with clindamycin, TMP-SMX, linezolid, or doxycycline

Parenteral therapy recommended for confirmed MRSA in Class 2 and 3 patients includes vancomycin, clindamycin for CA-MRSA isolates without inducible clindaymcin resistance, daptomycin, and linezolid; Tigecycline has recently been approved for complicated skin and soft tissue infections, including MRSA; Linezolid or vancomycin is recommended for MRSA diabetic

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hope for new class of anti-fatty acid construction antibiotics platensimycin [streptomyces platensius in african soil] inhibitor of FabF

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External Links Related to Methicillin resistant staph aureus/MRSA
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Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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