Why is community-associated MRSA spreading across the world and how will it change clinical practice?
Meticillin-resistant Staphylococcus aureus (MRSA) emerged in 1960 and over the following 40 years was a problem confined largely to the healthcare setting. In the late 1990s the first US reports of so-called community-associated MRSA (CA-MRSA) infections appeared. CA-MRSA infections were defined as MRSA infections occurring in patients who had no identifiable predisposing risk factors, such as healthy children and young adults. CA-MRSA is associated with a novel genetic profile and phenotype; it is remarkably fit and capable of spreading within communities, it is virulent and is often susceptible to multiple narrow-spectrum antimicrobials other than beta-lactams. CA-MRSA infections involve predominantly skin and soft tissue; however, necrotizing pneumonia and necrotizing fasciitis have been described. At present, several reports suggest that CA-MRSA may be replacing the hospital-acquired MRSA strains (HA-MRSA), with potentially catastrophic consequences. Given the rapid spread and the high virulence of CA-MRSA, global strategies are needed. Prompt, appropriate treatment, guided by the site and type of infection and risk factors for HA-MRSA or CA-MRSA, increases the chances of a successful outcome and is urgently needed.
Bassetti
Matteo
M
Infectious Diseases Division, S. Martino Hospital and University of Genoa School of Medicine, Genoa, Italy. matteo.bassetti@hsanmartino.it
Nicco
Elena
E
Mikulska
Malgorzata
M
D002648:Child; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D004196:Disease Outbreaks; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013207:Staphylococcal Skin Infections / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult