Disease Information for Methicillin resistant staph aureus/MRSA

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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