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Community-Acquired Methicillin-Resistant Staphylococcus Aureus Skin Infections

Implications for Patients and Practitioners

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Abstract

Dermatologists and other healthcare providers need to be aware of the epidemiology, clinical features, management, and prevention of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection. Currently, infection caused by CAMRSA is considered to represent a worldwide epidemic and infectious skin lesions are a frequent occurrence. Athletes, certain ethnic populations, children, homeless persons, homosexual men, household members of infected people, HIV-infected patients, intravenous drug abusers, military personnel, newborns, pregnant and postpartum women, tattoo recipients, and urban dwellers of lower socioeconomic status in crowded living conditions are individuals at increased risk of developing CAMRSA infection. Although the observed incidence of cutaneous CAMRSA lesions in patients with atopic dermatitis or other conditions that are characterized by a non-intact skin barrier is less than that reported in other groups of people at risk for this skin infection, close surveillance for the emergence of CAMRSA skin infection in children and adults with atopic dermatitis and other patients whose skin barrier is disrupted is justified since colonization by S. aureus in these individuals represents a potential reservoir for CAMRSA. It is also important to note that infection-associated risk factors are absent in many individuals who develop cutaneous CAMRSA infection.

CAMRSA skin lesions are pleomorphic. The most common presentations of CAMRSA infection are abscess, cellulitis, or both. These infectious lesions are not uncommonly misinterpreted by the patient as spider bites or insect bites. Other manifestations of cutaneous CAMRSA infection are impetigo, folliculitis, and paronychia.

Incision and drainage of abscesses, systemic antibacterial therapy, and adjunctive topical antibacterial treatment are the essential components of management of CAMRSA skin infections. At the initial visit, a bacterial culture of the infectious lesion is recommended to confirm identification of the pathogen and to determine antimicrobial susceptibility. Subsequently, based upon the reported antibacterial sensitivity, alteration (if necessary) of the patient’s empiric systemic antimicrobial treatment can be initiated.

Direct skin-to-skin transmission of the causative bacteria, damage to the skin’s surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of CAMRSA skin infection. The spread of cutaneous CAMRSA infection can potentially be prevented by incorporating personal, environmental, and healthcare measures that strive to eliminate the causes of acquisition and transmission of the bacteria.

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References

  1. Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and prevention. Int J Dermatol 2007; 46: 1–11

    Article  PubMed  CAS  Google Scholar 

  2. Kowalski TJ, Berbari EF, Osmon DR. Epidemiology, treatment, and prevention of community-acquired methicillin-resistant Staphylococcus aureus infections. Mayo Clin Proc 2005; 80: 1201–8

    Article  PubMed  Google Scholar 

  3. Del Giudice P, Blanc V, Durupt F, et al. Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections. Br J Dermatol 2006; 154: 118–24

    Article  PubMed  Google Scholar 

  4. Elston DM. Community-acquired methicillin-resistant Staphylococcus aureus. J Am Acad Dermatol 2007; 56: 1–16

    Article  PubMed  Google Scholar 

  5. Drews TD, Temte JL, Fox BC. Community-associated methicillin-resistant Staphylococcus aureus: review of an emerging public health concern. Wisconsin Med J 2006; 105 (1): 52–7

    Google Scholar 

  6. Grundmann H, Aires-de-Sousa M, Boyce J, et al. Emergence and resurgence of methicillin-resistant Staphylococcus aureus as a public-health threat. Lancet 2006; 368: 874–85

    Article  PubMed  Google Scholar 

  7. Kaplan SK. Community-acquired methicillin-resistant Staphylococcus aureus infections in children. Semin Pediatr Infect Dis 2006; 17: 113–9

    Article  PubMed  Google Scholar 

  8. Cohen PR. Cutaneous community-acquired methicillin-resistant Staphylococcus aureus infection: a personal perspective of a world-wide epidemic. Expert Rev Dermatol 2006; 1: 631–7

    Article  Google Scholar 

  9. Cohen PR, Kurzrock R. Community-acquired methicillin-resistant Staphylococcus aureus skin infection: an emerging clinical problem. J Am Acad Dermatol 2004; 50: 277–80

    Article  PubMed  Google Scholar 

  10. Cohen PR, Grossman ME. Management of cutaneous lesions associated with an emerging epidemic: community-acquired methicillin-resistant Staphylococcus aureus skin infections. J Am Acad Dermatol 2004; 51: 132–5

    Article  PubMed  Google Scholar 

  11. Nimmo GR, Coombs GW, Pearson JC, et al. Methicillin-resistant Staphylococcus aureus in the Australian community: an evolving epidemic. Med J Australia 2006; 184: 384–8

    PubMed  Google Scholar 

  12. Paintsil E. Pediatric community-acquired methicillin-resistant Staphylococcus aureus infection and colonization: trends and management. Curr Opin Pediatr 2007; 19: 75–82

    Article  PubMed  Google Scholar 

  13. Cunha BA. Methicillin-resistant Staphylococcus aureus: clinical manifestations and antimicrobial therapy. Clin Microbiol Infect 2005; 11 Suppl. 4: 33–42

    Article  PubMed  CAS  Google Scholar 

  14. Rybak MJ, LaPlante KL. Community-associated methicillin-resistant Staphylococcus aureus: a review. Pharmacotherapy 2005; 25: 74–85

    Article  PubMed  CAS  Google Scholar 

  15. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community and health care-associated methicillin-resistant Staphylococcus aureus. JAMA 2003; 290: 2976–84

    Article  PubMed  CAS  Google Scholar 

  16. Weber JT. Community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2005; 41: 269–72

    Article  Google Scholar 

  17. Le J, Lieberman JM. Management of community-associated methicillin-resistant Staphylococcus aureus infections in children. Pharmacotherapy 2006; 26: 1758–70

    Article  PubMed  CAS  Google Scholar 

  18. Szumowski JD, Cohen DE, Kanaya F, et al. Treatment and outcomes of infections by methicillin-resistant Staphylococcus aureus at an ambulatory clinic. Antimicrob Agents Chemother 2007; 51: 423–8

    Article  PubMed  CAS  Google Scholar 

  19. Boyle-Vavra S, Daum RS. Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton-Valentine leukocidin. Lab Invest 2007; 87: 3–9

    Article  PubMed  CAS  Google Scholar 

  20. Singer J, Dowler M, Bosscher B. Emergency department perspective on methicillin-resistant Staphylococcus aureus. Pediatr Emergency Care 2006; 22: 270–6

    Article  Google Scholar 

  21. Frank AL, Marcinak JF, Mangat PD, et al. Community-acquired and clindamycin-susceptible methicillin-resistant Staphylococcus aureus in children. Pediatr Infect Dis 1999; 18: 993–1000

    Article  CAS  Google Scholar 

  22. Huijsdens XW, van Santen-Verheuve MG, Spalburg E, et al. Multiple cases of familial transmission of community-acquired methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006; 44: 2994–6

    Article  PubMed  CAS  Google Scholar 

  23. Centers for Disease Control and Prevention. Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns: Chicago and Los Angeles county, 2004. Morb Mortal Wkly Rep 2006; 55: 329–32

    Google Scholar 

  24. Fortunov RM, Hulten KG, Hammerman WA, et al. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006; 118: 874–81

    Article  PubMed  Google Scholar 

  25. Gilbert M, MacDonald J, Gregson D, et al. Outbreak in Alberta of community acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness, or incarceration. Canadian Med Assoc J 2006; 175: 149–54

    Article  Google Scholar 

  26. Crum-Cianflone N, Hale B, Burgi A, et al. TriService AIDS Clinical Consortium: increasing rates of community-acquired MRSA infections among HIV-infected persons [abstract MOAB0304: oral abstract session 8-14-06, 15: 00-15:15 (SR9)]. XVI International AIDS Conference; 2006 Aug 13-18; Toronto, Canada. Clin Infect Dis 2006; 43 (8): iii

    Google Scholar 

  27. Chen KT, Huard RC, Della-Latta P, et al. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006; 108: 482–7

    Article  PubMed  Google Scholar 

  28. Gibbs RS. Emerging infections in obstetric and gynecologic practice. Obstet Gynecol 2006; 108: 480–1

    Article  PubMed  Google Scholar 

  29. Ruhe JJ, Monson T, Bradsher RW, et al. Use of long-acting tetracyclines for methicillin-resistant Staphylococcus aureus infections: case series and review of the literature. Clin Infect Dis 2005; 40: 1429–34

    Article  PubMed  CAS  Google Scholar 

  30. Stemper ME, Brady JM, Qutaishat SS, et al. Shift in Staphylococcus aureus clone linked to an infected tattoo. Emerg Infect Dis 2006; 12: 1444–6

    Article  PubMed  Google Scholar 

  31. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients: Ohio, Kentucky, and Vermont, 2004-2005. Morb Mortal Wkly Rep 2006; 55: 677–9

  32. Bratu S, Landman D, Gupta J, et al. A population-based study examining the emergence of community-associated methicillin-resistant Staphylococcus aureus USA 300 in New York City. Ann Clin Microbiol Microbials 2006; 5: 29

    Google Scholar 

  33. Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infection presenting as an axillary abscess with cellulitis in a college athlete. SKINmed: Dermatology for the Clinician 2005; 4: 115–8

    Article  Google Scholar 

  34. Cohen PR. Cutaneous community acquired methicillin-resistant Staphylococcus aureus infection in participants of athletic activities. South Med J 2005; 98: 596–602

    Article  PubMed  Google Scholar 

  35. Cohen PR. The skin in the gym: a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus in athletes. Clin Dermatol. In press

  36. Huijsdens XW, van Lier AMC, van Kergten E, et al. Methicillin-resistant Staphylococcus aureus in Dutch soccer team. 2006; 12: 1584–6

    CAS  Google Scholar 

  37. Cook HA, Furuya EY, Larson E, et al. Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2007; 44: 410–3

    Article  PubMed  CAS  Google Scholar 

  38. Eady EA, Cove JH. Staphylococcal resistance revisited: community-acquired methicillin resistant Staphylococcus aureus: an emerging problem for the management of skin and soft tissue infections. Curr Opin Infect Dis 2003; 16: 103–24

    Article  PubMed  CAS  Google Scholar 

  39. Suh LM, Honig PJ, Yan AC. Methicillin-resistant Staphylococcus aureus skin abscess in a pediatric patient with atopic dermatitis: a case report. Cutis 2006; 78: 113–6

    PubMed  Google Scholar 

  40. Roesch A, Linde H-J, Landthaler M, et al. Elimination of a community-acquired methicillin-resistant Staphylococcus aureus infection in a nurse with atopic dermatitis: critical situations. Arch Dermatol 2005; 141: 1520–2

    Article  PubMed  Google Scholar 

  41. Aly R, Maibach HI, Shinefield HR. Microbial flora of atopic dermatitis. Arch Dermatol 1977; 113: 780–2

    Article  PubMed  CAS  Google Scholar 

  42. Arkwright PD, Daniel TO, Sanyal D, et al. Age-related prevalence and antibiotic resistance of pathogenic Staphylococci and Streptococci in children with infected atopic dermatitis at a single-specialty center. Arch Dermatol 2002; 138: 939–41

    Article  PubMed  Google Scholar 

  43. Hon KLE, Lam MCA, Leung TF, et al. Clinical features associated with nasal Staphylococcus aureus colonisation in Chinese children with moderate-to-severe atopic dermatitis. Ann Acad Med Singapore 2005; 34: 602–5

    PubMed  CAS  Google Scholar 

  44. Klein PA, Greene WH, Fuhrer J, et al. Prevalence of methicillin-resistant Staphylococcus aureus in outpatients with psoriasis, atopic dermatitis, or HIV infection. Arch Dermatol 1997; 133: 1463–5

    Article  PubMed  CAS  Google Scholar 

  45. Nakata K, Inoue Y, Harada J, et al. A high incidence of Staphylococcus aureus colonization in the external eyes of patients with atopic dermatitis. Ophthalmology 2000; 107: 2167–71

    Article  PubMed  CAS  Google Scholar 

  46. Oshima Y, Ohji M, Inoue Y, et al. Methicillin-resistant Staphylococcus aureus infections after scleral buckling procedures for retinal detachments associated with atopic dermatitis. Ophthalmology. 1999; 106: 142–7

    Article  PubMed  CAS  Google Scholar 

  47. Setyadi HG, Cohen PR, Schulze KE, et al. Trigeminal trophic syndrome. South Med J 2007; 100: 43–8

    Article  PubMed  Google Scholar 

  48. Konstantopoulou M, O’Dwyer EM, Steele JC, et al. Pyodermatitis-pyostomatitis vegetans complicated by methicillin-resistant Staphylococcus aureus infection. Clin Exp Dermatol 2005; 30: 666–8

    Article  PubMed  CAS  Google Scholar 

  49. .Scoffle NN, Cohen PR. Images in clinical medicine: Sarcopetes scabiei infestation. N Engl J Med 2004; 350 (22): e20

    Article  Google Scholar 

  50. Cohen PR. What caused this abscess and cellulitis? Diagnosis: community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) skin infection. Skin & Aging 2004; 12 (10): 56–8

    Google Scholar 

  51. Cohen PR. Enlarging facial abscess with cellulitis community-acquired methicillin-resistant Staphylococcus aureus. Cortlandt Forum 2005; 18 (4): 42, 45

    Google Scholar 

  52. Cohen PR. Enlarging abscess with cellulitis (community-acquired methicillin resistant Staphylococcus aureus). Clin Advisor 2005; 8 (9): 60, 63

    Google Scholar 

  53. Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infection presenting as a periumbilical folliculitis: case reports. Cutis 2006; 77: 229–31

    PubMed  Google Scholar 

  54. Pagac BB, Reiland RW, Bolesh DT, et al. Skin lesions in barracks: consider community-acquired methicillin-resistant Staphylococcus aureus infection instead of spider bites. Mil Med 2006; 171: 830–2

    PubMed  Google Scholar 

  55. Miller LG, Spellberg B. Treatment of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections with drainage but no antibiotic therapy [letter]. Pediatr Infect Dis J 2004; 23: 795

    PubMed  Google Scholar 

  56. Lee MC, Rios AM, Aten MF, et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus.Pediatr Infect Dis J 2004; 23: 123–7

    Article  PubMed  Google Scholar 

  57. Rios AM, Lee MC, Hardy RD. Staphylococcal skin infections: reply. Pediatr Infect Dis J 2004; 23: 795–6

    Google Scholar 

  58. Barnes 2nd EV, Dooley DP, Hepburn MJ, et al. Outcomes of community-acquired, methicillin-resistant Staphylococcus aureus, soft tissue infections with antibiotics other than vancomycin. Mil Med 2006; 171: 504–7

    PubMed  Google Scholar 

  59. Cohen PR. Empiric treatment of skin infections: Dr. Cohen responds [letter]. Clin Advisor 2006, 12

  60. Cohen PR. Cutaneous MRSA treatment (87-6) [advisor forum]. Clin Advisor 2006; 9 (1): 54

    Google Scholar 

  61. Ashourian N, Cohen PR. Systemic drugs for infectious diseases (chapter 4). In: Wolverton SE, editor. Comprehensive dermatologic drug therapy. 2nd ed. Philadelphia (PA): Saunders Elsevier, 2007: 39–74

    Google Scholar 

  62. Carter MK, Ebers VA, Younes BK, et al. Doxycycline for community-associated methicillin-resistant Staphylococcus aureus skin and soft-tissue infections. Ann Pharmacotherapy 2006; 40: 1693–5

    Article  Google Scholar 

  63. Drew RH. Emerging options for treatment of invasive, multidrug-resistant Staphylococcus aureus infections. Pharmacotherapy 2007; 27: 227–49

    Article  PubMed  CAS  Google Scholar 

  64. John CC, Schreiber JR. Therapies and vaccines for emerging bacterial infections: learning from methicillin-resistant Staphylococcus aureus. Pediatr Clin N Am 2006; 53: 699–713

    Article  Google Scholar 

  65. Stranger-Jones YK, Bae T, Schneewind O. Vaccine assembly from surface proteins of Staphylococcus aureus. Proc Natl Acad Sci 2006; 103: 16942–7

    Article  PubMed  CAS  Google Scholar 

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No sources of funding were used to assist in the preparation of this article. The author has no conflicts of interest that are directly relevant to the content of this article.

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Cohen, P.R. Community-Acquired Methicillin-Resistant Staphylococcus Aureus Skin Infections. AM J Clin Dermatol 8, 259–270 (2007). https://doi.org/10.2165/00128071-200708050-00001

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