Abstrak
Recent studies suggest that the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is changing and it is no longer only hospital-acquired but may also be community-acquired. Community-acquired Staphylococcus aureus (CA-MRSA) strains are emerging threats and are becoming important public health problem because they have been associated with high morbidity and mortality in the community. This review aims at highlighting the characteristics of these emergent strains of Staphylococcus aureus with a view to better management and control.The review, which consists of literature search of journals and chapters in books, provides an insight to the emergence of strains of methicillin-resistant Staphylococcus aureus (MRSA)in the community. It focuses on the changing epidemiology, molecular basis of resistance, pathogenesis, laboratory investigations and treatment of infections caused by these new strains. It is interesting to note that as a result of the emergence of these strains of methicillin-resistant Staphylococcus aureus (MRSA) in the community, the treatment options for MRSA is changing. This is due to the fact that these community strains have unique combinations of resistance traits and virulence factors which have enhanced their ability for colonization and pathogenesis. Their emergence in the community heralds a need for new approaches to the management of both suspected and confirmed staphylococcal infections. Since CA-MRSA constitutes a public health problem, there should be increased vigilance in the diagnosis and management of suspected and confirmed staphylococcal infections.
Keywords: CA-MRSA, epidemiology, public health
Résumé
Les études récentes suggèrent que l’épidémiologie de la résistance des staphylocoques aureus la méthicilline (MRSA) a changé et ne nécessite plus seulement l’attention de l’hôpital mais la communauté. Les formes de Staphylocoques aureus (CA-MRSA) de la communauté sont des menaces émergentes et deviennent un problème de santé publique parce qu’elles sont associées à un taux de souffrance et de mortalité élevé dans la communauté. Cette revue a pour but d’illuminer les caractéristiques des formes des Staphylocoques aureus émergentes et de mieux prendre soins et contrôler les changements épidémiologiques, la base moléculaire de la résistance, la pathogenèse, les investigations en laboratoire et le traitement des infections. Il est intéressant de noter les options de traitement variaient selon les nouvelles formes de Staphylocoques aureus (MRSA) résistant à la méthicilline dans la communauté, et des formes de combinaisons de la résistance associés a d’autres facteurs de virulence augmentant l’habilité pour la colonisation et la pathogenèse. Leur émergence dans la communauté démontre le besoin des nouvelles approches des soins aux cas des infections des staphylocoques suspectés et confirmés. Bien que ces maladies constituent un problème de santé publique, Une augmentation de la vigilance dans le diagnostic et les soins des cas des infections des staphylocoques suspectés et confirmés.
Correspondence: Dr. A.O. Okesola, Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: abiolaokesola@yahoo.com
Referensi
Shopsin B, Mathema B, Martinez J, et al. Prevalence of MRSA in the community. J Infect Dis 2000; 182:359-362.
Salmenlinna S, Lyytikainen O and Vuopio-Varkila J. Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 2002; 8(6):602–607.
Hunt C, Dionne M, Delome M, et al. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus- Minnesota and North Dakota.Arch Dermatol 1999; 135: 1566-1568
Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin – resistant Staphylococcus aureus carrying the Panton-Valentine Leucocidin genes;Worldwide emergence. Emerg Infect Dis 2003; 9(8): 978–984.
Grundmann H, Tami A, Hori S, et al. Nottingham Staphylococcus aureus population study: prevalence of MRSA among elderly people in the community. BMJ 2002; 8: 324 (7350): 1365 –1366.
Liassine N, Auckenthaler R, Descombes MC, et al. Community-acquired methicillin – resistant Staphylococcus aureus isolated in Switzerland contains the Panton–Valentine Leukocidin or exfoliative toxin genes. J Clin Microbiol 2004;42 (2):825–828.
Boyle-Vavra S and Daum RS. Community-acquired methicillin-resistant Staphylococcus aureus; The Role of Panton–Valentine Leukocidin. Lab Investg 2007; 87: 3-9.
Pan ES, Diep BA, Charlebois ED, et al. Population dynamics of nasal strains of methicillin–resistant Staphylococcus aureus and their relation to community-associated disease activity. J Infect Dis 2005;192: 811–818.
Salgado CD, Farr BM and Calfee DP. Community–acquired methicillin–resistant Staphylococcus aureus:a meta-analysis of prevalence and risk factors. Clin Infect Dis 2003; 36: 131 – 139.
Klevens, R.M., et al. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin. Infect. Dis 2006; 42:389-391.
Kirby, W.M. Extraction of a highly potent penicillin inactivator from penicillin resistant Staphylococci. Science 1944; 99:452-453.
Carleton HA, Diep BA, Charlebis ED, et al Community-adapted methicillin–resistant Staphylococcus aureus (MRSA); population dynamics of an expanding community reservoir of MRSA.J Infect Dis 2004; 190: 1730 – 1738.
Harold BC, Immergluck LC, Maranan M, et al.Community–acquired methicillin– resistant Staphylococcus aureus in children with no predisposing risk. JAMA 1997; 279: 593–598.
Cohen, Philip R. Community–acquired methicillin–resistant Staphylococcus aureus skin infections: Implications for Patients and Practitioners. Ing 2007; 8 (5); 259 – 270.
Schulz P, Allen M, Murray Q, et al. Infections due to community–acquired methicillin–resistant Staphylococcus aureus; an emergent epidemic in Kentucky. J Ky Med Assoc 2005; 103: 194 –203.
Kluytmans–Vandenberg MF, Kluytmans JA. Community– acquired methicillin – resistant Staphylococcus aureus: current perspectives. Clin Microbiol Infect 2006; 12 (1): 9-15.
Padmanabhan RA, Fraser TG. The emergence of methicillin–resistant Staphylococcus aureus in the community. Cleve Clin J Med 2005;72: 235 – 241.
Okesola AO, Oni AA, Bakare RA. Prevalence and antibiotic sensitivity pattern of methicillin-resistant Staphylococcus aureus in Ibadan, Nigeria. J Hosp Inf 1999;41:74-75.
Taiwo SS, Bamidele M, Omonigbehin,EA et al. Molecular epidemiology of methicillin–resistant Staphylococcus aureus in Ilorin, Nigeria. W Afr J Med 2005;24:100-106.
MA XX, Ito T, Tientasitorn C, et al. Novel type of Staphylococcal Cassette Chromosome mec identified in community-acquired methicillin – resistant Staphylococcus aureus strains. Antimicrob Agents Chemother 2002; 46: 1147 –1152.
Dyke K and Gregory P. Resistance mediated by beta-lactamase.In:The Staphylococci in human disease. Crossley KB, Archer GL(Eds). Churchhill Livingstone, Oxford,UK, 1997.139-157.
Zhang HZ, Hackbath CJ, Chansky KM and Chambers HF. A proteolytic transmembrane signaling pathway and resistance to beta-lactams in staphylococci.Science 2001; 291(5510):1962-1965.
Boyle-Vavra S, Ereshetsky B, Wang CC and Daum RS. Successful multiresistant community-associated methicillin–resistant Staphylococcus aureus lineage from Taipei, Taiwan, that carries either the novel Staphylococcal Chromosome Cassette mec (SCCmec) type (Vsub T) or SCCmec type IV. J Clin Microbiol 2005;43:4719 –4730.
McDougal LK, Steward CD, Kiligore GE, et al. Pulsed–field gel electrophoresis typing of oxacillin- resistant Staphylococcus aureus isolates from the United States; establishing a national database. J Clin Microbiol 2003; 41: 5113 –5120.
Egnia JM and Chambers HF. Community–acquired methicillin–resistant Staphylococcus aureus: epidemiology and potential virulence factors. Curr Infect Dis Rep 2003; 5: 459–466.
Ward PD, Turner WH. Identification of staphylococcal Panton-Valentine leukocidin as a potent dermonecrotic toxin. Infect Immun 1980; 28: 393 – 397.
Lina G, Piemont Y, Godail- Gamot F, et al. Involvement of Panton-Valentine leukocidin- producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29: 1128 – 1132.
Voyich JM, Braughton KR, Sturdevant DE, et al. Differential distribution and expression of Panton-Valentine leukocidin among community-acquired methicillin-resistant Staphylococcus aureus strains. J Clin Microbiol 2005; 43: 3373 – 3379.
Miller LG, Perdreau-Renington F, Rieg G, et al. Necrotizing fasciitis caused by community–associated methicillin–resistant Staphylococcus aureus in Los Angeles. N Eng J Med 2005;352:1445-1453.
Voyich JM, Otto M, Mathema B, et al. Is Panton-Valentine leukocidin the major Virulence determinant in community–associated methicillin- resistant Staphylococcus aureus disease. J Infect Dis 2006; 194: 1761 –1770.
Robinson DA, Kearns AM, Holmes A, et al. Re-emergence of early pandemic Staphylococcus aureus as a community-acquired methicillin- resistant clone. Lancet 2005; 365: 1256 –1258.
Dufour P, Gillet Y, Bes M, et al. Community-acquired methicillin–resistant Staphylococcus aureus infection in France: Emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis 2002;35: 819–824.
Liao CH, Chen SY, Chang SC,et al. Characteristics of community-acquired and healthcare–associated Staphylococcus aureus bacteremia in patients treated at the emergency department of a teaching hospital. Diagn Microbiol Infect Dis 2005; 53: 85-92.
Fridkin SK, Hageman JC, Morrison M, et al. Methicillin–resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005; 352: 1436 – 1444.
Okuma K, Iwakawa K, Turnidge JD, et al. Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002; 40: 4289 –4294.
Oliveira DC, de Lencastre H. Multiplex PCR Strategy for rapid identification of structural types and Variants of the mec elements in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2002; 46:2155 –2161.
Aires-de-Sousa M, Boye K, de Lancastre H, et al. High interlaboratory reproducibility of DNA sequence-based typing of bacteria in a Multicenter study. J Clin Microbiol 2006; 44: 619 –621.
Diep BA, Perdreu-Remmington F and Sensabaugh GF. Clonal characterization of Staphylococcus aureus by Multilocus restriction fragment typing, a rapid screening approach for molecular epidemiology. J Clin Microbiol 2003; 41: 4559 –4564.
Melles DC, Govkink RF, Boeleus HA, et al. Natural population dynamics and expansion of pathogenic clones of Staphylococcus aureus .J Clin Invest 2004; 114: 1732 – 1740.
Ghebredhin B, Olugbosi MO, Raji AM, et al. Emergence of a community- associated methicillin-resistant Staphylococcus aureus strain with a unique resistance profile in Southwest Nigeria. J Clin Microbiol 2009:2975-2980.
Millership S, Herris J and Batchelor N. Methicillin–resistant Staphylococcus aureus in the community in West Essex. Epidemiology Infect 2006; 134: 301-305.
Naimi TS, Le Dell KH, Como – Sabelti K, et al. Comparison of community and healthcare associated methicillin-resistant Staphylococcus aureus infection . JAMA 2003; 290: 2976-2984.
Anon.Daptomycin (Cubicin) for skin and soft tissue infections. Med Lett Drugs Ther 2004; 6: 11-12.
Raw GG. Should clindamycin be used in treatment of patients with Infections caused by erythromycin- resistant staphylococci ? J Antimicrob Chemother 2000; 45:715.
Farrington M, Red path C, Trundle C,et al. Winning the battle but losing the war, methicillin–resistant Staphylococcus aureus (MRSA) Infection at a teaching hospital. Q J Med 1998.91; 539-548.
British Society for Antimicrobial Chemotherapy Revised guidelines for the Control of methicillin– resistant Staphylococcus aureus infection in hospitals. British Society for Antimicrobial Chemotherapy, Hospital Infection Society and the Infection Control Nurses Association. J Hosp Infect 1998; 39: 253 – 290.
Drinkovic D, Fuller ER, Shore KP, et al. Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. J Antimicrobial Chemother 2001; 48: 315-516.