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      Skin Infections Caused by Staphylococcus aureus

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          Abstract

          Staphylococcus aureus is the most common pathogen involved in skin infections worldwide, regardless of the patient’s age, the climate or geographical area. The main skin clinical manifestations can be linked to a few toxins produced by the bacteria, which give rise to a rich and varied clinical spectrum. Panton Valentine leucocidin, exfoliatins, enterotoxins and toxin shock syndrome toxin 1 are the main toxins involved in most dermatological manifestations associated with S. aureus. Other less frequent cutaneous manifestations can occur in endocarditis, bacteraemia. Currently, the most important event is worldwide emergence of community-acquired S. aureus resistant to methicillin (CA-MRSA), mainly causing skin infections.

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          Methicillin-resistant S. aureus infections among patients in the emergency department.

          Gregory J Moran, Anusha Krishnadasan, Rachel Gorwitz … (2006)
          Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized in infections among persons in the community without established risk factors for MRSA. We enrolled adult patients with acute, purulent skin and soft-tissue infections presenting to 11 university-affiliated emergency departments during the month of August 2004. Cultures were obtained, and clinical information was collected. Available S. aureus isolates were characterized by antimicrobial-susceptibility testing, pulsed-field gel electrophoresis, and detection of toxin genes. On MRSA isolates, we performed typing of the staphylococcal cassette chromosome mec (SCCmec), the genetic element that carries the mecA gene encoding methicillin resistance. S. aureus was isolated from 320 of 422 patients with skin and soft-tissue infections (76 percent). The prevalence of MRSA was 59 percent overall and ranged from 15 to 74 percent. Pulsed-field type USA300 isolates accounted for 97 percent of MRSA isolates; 74 percent of these were a single strain (USA300-0114). SCCmec type IV and the Panton-Valentine leukocidin toxin gene were detected in 98 percent of MRSA isolates. Other toxin genes were detected rarely. Among the MRSA isolates, 95 percent were susceptible to clindamycin, 6 percent to erythromycin, 60 percent to fluoroquinolones, 100 percent to rifampin and trimethoprim-sulfamethoxazole, and 92 percent to tetracycline. Antibiotic therapy was not concordant with the results of susceptibility testing in 100 of 175 patients with MRSA infection who received antibiotics (57 percent). Among methicillin-susceptible S. aureus isolates, 31 percent were USA300 and 42 percent contained pvl genes. MRSA is the most common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments in 11 U.S. cities. When antimicrobial therapy is indicated for the treatment of skin and soft-tissue infections, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage. Copyright 2006 Massachusetts Medical Society.
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            Community-associated meticillin-resistant Staphylococcus aureus.

            Frank DeLeo, Michael Otto, Barry N. Kreiswirth … (2010)
            Meticillin-resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide, and causes substantial morbidity and mortality. Health-care-associated MRSA infections arise in individuals with predisposing risk factors, such as surgery or presence of an indwelling medical device. By contrast, many community-associated MRSA (CA-MRSA) infections arise in otherwise healthy individuals who do not have such risk factors. Additionally, CA-MRSA infections are epidemic in some countries. These features suggest that CA-MRSA strains are more virulent and transmissible than are traditional hospital-associated MRSA strains. The restricted treatment options for CA-MRSA infections compound the effect of enhanced virulence and transmission. Although progress has been made towards understanding emergence of CA-MRSA, virulence, and treatment of infections, our knowledge remains incomplete. Here we review the most up-to-date knowledge and provide a perspective for the future prophylaxis or new treatments for CA-MRSA infections. Copyright 2010 Elsevier Ltd. All rights reserved.
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              Methicillin-resistant Staphylococcus aureus disease in three communities.

              Scott K. Fridkin, Jeffrey Hageman, Melissa Morrison … (2005)
              Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. The national burden and clinical effect of this novel presentation of MRSA disease are unclear. We evaluated MRSA infections in patients identified from population-based surveillance in Baltimore and Atlanta and from hospital-laboratory-based sentinel surveillance of 12 hospitals in Minnesota. Information was obtained by interviewing patients and by reviewing their medical records. Infections were classified as community-associated [correction] MRSA disease if no established risk factors were identified. From 2001 through 2002, 1647 cases of community-associated [correction] MRSA infection were reported, representing between 8 and 20 percent of all MRSA isolates. The annual disease incidence varied according to site (25.7 cases per 100,000 population in Atlanta vs. 18.0 per 100,000 in Baltimore) and was significantly higher among persons less than two years old than among those who were two years of age or older (relative risk, 1.51; 95 percent confidence interval, 1.19 to 1.92) and among blacks than among whites in Atlanta (age-adjusted relative risk, 2.74; 95 percent confidence interval, 2.44 to 3.07). Six percent of cases were invasive, and 77 percent involved skin and soft tissue. The infecting strain of MRSA was often (73 percent) resistant to prescribed antimicrobial agents. Among patients with skin or soft-tissue infections, therapy to which the infecting strain was resistant did not appear to be associated with adverse patient-reported outcomes. Overall, 23 percent of patients were hospitalized for the MRSA infection. Community-associated MRSA infections are now a common and serious problem. These infections usually involve the skin, especially among children, and hospitalization is common. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acta Derm Venereol
                Journal ID (iso-abbrev): Acta Derm Venereol
                Journal ID (publisher-id): ActaDV
                Title: Acta Dermato-Venereologica
                Publisher: Society for Publication of Acta Dermato-Venereologica
                ISSN (Print): 0001-5555
                ISSN (Electronic): 1651-2057
                Publication date (Electronic): 20 April 2020
                Publication date Collection: 2020
                Volume: 100
                Issue: 9
                Electronic Location Identifier: 5725
                Affiliations
                Infectiology-Dermatology Unit, Hospital of Fréjus-Saint-Raphaël, Fréjus, France
                Author notes
                Corr: Pascal del Giudice, Service Infectiologie-Dermatologie- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 240 Avenue de Saint Lambert, FR-83600, Fréjus, France. E-mail: del-giudice-p@ 123456chi-fsr.fr
                Article
                Publisher ID: ActaDV-100-9-5725
                DOI: 10.2340/00015555-3466
                PMC ID: 9128951
                PubMed ID: 32207539
                SO-VID: 640fc344-bf7b-48e6-bd93-d7ecb116aacb
                Copyright © © 2020 Acta Dermato-Venereologica
                License:

                This is an open access article under the CC BY-NC license

                History
                Date accepted : 19 March 2020
                Categories
                Subject: Review Article

                Keywords: skin infections,staphylococcus aureus,bacterial skin infections,cellulitis,furuncle,abscess
                Data availability:
                Keywords: skin infections, staphylococcus aureus, bacterial skin infections, cellulitis, furuncle, abscess

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