An analysis of a community-acquired pathogen in a Kentucky community: methicillin-resistant Staphylococcus aureus.
BACKGROUND
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been reported in patients with recognized predisposing risk factors in several cities in the United States and across the world. Reviewing risk factors in adult patients with CA-MRSA in Kentucky has not been reported.


OBJECTIVE
To determine the risk factors of 15 patients with CA-MRSA in Louisville KY, to compare the sensitivities of each pathogen and to recommend management.


METHODS
An infectious diseases private practice in Louisville, KY.


METHODS
This is a case series of patients with CA-MRSA. The disease course for each patient was reviewed for risk factors, such as participation in physical contact sports and prison exposure. The antimicrobial sensitivities of each pathogen were also reviewed. Recommendations were produced from the information obtained.


RESULTS
A total of 15 patients were reviewed. Five patients had a family member or significant-other with a current CA-MRSA infection. Three had traditional risk factors (healthcare workers). All of the isolates were susceptible to vancomycin and resistant to oxacillin. All of the isolates tested for trimethoprim/sulfamethoxazole (TMP/SMX), tetracycline, and rifampin were sensitive. A majority (83%) of those tested for clindamycin and only 50% of those tested for levofloxacin were sensitive. All isolates tested for cefazolin were resistant.


CONCLUSIONS
An emerging risk factor for acquiring an MRSA skin and soft tissue infection is having a significant-other with a current diagnosis of CA-MRSA. After incision and drainage, a review of the antimicrobial sensitivities indicates that oral treatment may be adequate for a selection of cases.
Arnold
Forest W
FW
University of Louisville School of Medicine, KY 40292, USA. F.Arnold@louisville.edu
Wojda
Barbara
B
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002437:Cefazolin / Q000494:pharmacology; D002981:Clindamycin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D006801:Humans; D007629:Kentucky; D064704:Levofloxacin; D008297:Male; D008712:Methicillin / Q000494:pharmacology / Q000627:therapeutic use*; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015242:Ofloxacin / Q000494:pharmacology; D010068:Oxacillin / Q000494:pharmacology; D012293:Rifampin / Q000494:pharmacology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013420:Sulfamethoxazole / Q000494:pharmacology; D013752:Tetracycline / Q000494:pharmacology; D014295:Trimethoprim / Q000494:pharmacology; D014640:Vancomycin / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D004917:Erythromycin; D064704:Levofloxacin; D014640:Vancomycin; D015242:Ofloxacin; D014295:Trimethoprim; D013752:Tetracycline; D002437:Cefazolin; D013420:Sulfamethoxazole; D008712:Methicillin; D010068:Oxacillin; D012293:Rifampin