Therapy-refractory Panton Valentine Leukocidin-positive community-acquired methicillin-sensitive Staphylococcus aureus sepsis with progressive metastatic soft tissue infection: a case report

We report a case of fulminant multiple organ failure including the Acute Respiratory Distress Syndrome (ARDS), haemodynamic, and renal failure due to community-acquired methicillin-sensitive Panton Valentine Leukocidin (PVL) positive spa-type 284 (ST121) Staphylococcus aureus septic shock. The patient's first clinical symptom was necrotizing pneumonia. Despite organism-sensitive triple antibiotic therapy with linezolid, imipenem and clindamycin from the first day of treatment, progressive abscess formation in multiple skeletal muscles was observed. As a result, repeated surgical interventions became necessary. Due to progressive soft tissue infection, the anti-microbial therapy was changed to a combination of clindamycin and daptomycin. Continued surgical and antimicrobial therapy finally led to a stabilisation of the patients' condition. The clinical course of our patient underlines the existence of a "PVL-syndrome" which is independent of in vitro Staphylococcus aureus susceptibility. The PVL-syndrome should not only be considered in patients with soft tissue or bone infection, but also in patients with pneumonia. Such a condition, which may easily be mistaken for uncomplicated pneumonia, should be treated early, aggressively and over a long period of time in order to avoid relapsing infection

Ergebnisse der Tätigkeit des Nationalen Referenzzentrums für Staphylokokken im Jahr 1998

Dieser Bericht bezieht sich auf das Auftreten und die Ausbreitung von S. aureus-Stämmen mit besonderer klinischer und epidemiologischer Bedeutung. Die Ergebnisse der Typisierung von MRSA unterschiedlicher klinischer Herkünfte in Deutschland weisen auf eine kontinuierliche Ausbreitung bestimmter Epidemiestämme zwischen Krankenhäusern hin. Daneben wird der Transfer des mecA-Gens in Stämme beoachtet, die zu bisher diesbezüglich empfindlichen klonalen Gruppen von S. aureus gehören. Diese neu entstandenen MRSA sind noch empfindlich gegen eine Reihe von Antibiotika; dies führt zu weniger „breiten” Resistenzphänotypen. Weiterhin erwähnenswert im Hinblick auf die Diagnostik toxinvermittelter S. aureus-Infektionen sind die klinischen Fälle des Toxic-Schock-Syndroms verursacht durch S. aureus secC, nicht aber tst.This report focusses on the emergence and spread of S. aureus with special clinical and epidemiological significance. Results from typing MRSA originating from different clinical sources in all Germany reveal that there is a continuing interhospital dissemination of definite epidemic strains and also a spread of the mecA gene to clonal groups of S. aureus which have been until now sensitive. These newly emerging MRSA are still sensitive to a number of other antibiotics. This results in less broad resistance phenotypes of currently disseminated MRSA. Worth mentioning with regard to diagnostics are also three clinical cases of staphylococcal toxic shock syndrome caused by S. aureus possessing secC and not tst

Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002-2005

Background: Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulence determinants. Strains harboring the lukS-lukF gene (which codes for Panton-Valentine leukocidin) are frequently associated with severe furunculosis. Generally applicable strategies for the control of community outbreaks of furunculosis have not been defined. Methods: We report the investigation and successful termination of an outbreak of furunculosis due to lukS-lukF-positive S. aureus in a German village (n=144). Nasal swab specimens were obtained from village residents. A retrospective cohort study was conducted. Nasally colonized persons, persons who had current furuncles or who had experienced relapsing furuncles since 2002, and their family members underwent stringent decolonization measures using mupirocin nasal ointment and disinfecting wash solution. Multiple nasal swab specimens were obtained to monitor the long-term outcome of decolonization measures. Results: From January 1998 through December 2004, 42 cases and 59 relapses of furunculosis were identified by active case finding. Of 140 participants tested, 51 (36%) were found to be nasally colonized with S. aureus. In 9 participants, the strain was positive for lukS-lukF. No methicillin resistance was detected. Risk of furunculosis was associated with contact with case patients (relative risk, 6.8; 95% confidence interval, 3.2-14.3) and nasal colonization with a lukS-lukF-positive strain of S. aureus (relative risk, 3.6; 95% confidence interval, 2.3-5.9). Passive surveillance implemented in January 2005 did not detect any case of lukS-lukF-positive, S. aureus-associated furuncles in this village. Conclusion: This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population

Methicillin-resistente Staphylokokken: In Altenheimen ebenso häufig vertreten wie in Krankenhäusern

Präventionsstrategien zielen auf Einhaltung von Hygienemaßnahmen und eine bessere Zusammenarbeit der Beschäftigten im Gesundheitswesen

Studie zum Vorkommen von Methicillin-resistenten Staphylococcus aureus in Alten- und Altenpflegeheimen in Nordrhein-Westfalen

Anlass für diese Studie war die weltweite Zunahme von MRSA-Infektionen im Krankenhaus und der damit verbundenen Frage über das Vorkommen von MRSA in Alten- und Altenpflegeheimen. Von März 2000 bis März 2001 wurde von 21 Gesundheitsämtern in Nordrhein-Westfalen insgesamt von 1057 Altenheimbewohnern und 193 Pflegekräften auf freiwilliger Basis Untersuchungsmaterial gewonnen und mit dem ausgefüllten Fragebogen an das lögd NRW weitergeleitet. In dieser Querschittsstudie zeigten 32 Bewohner und eine Beschäftigte einen positiven MRSA-Befund. Dies entspricht einer MRSA-Prävalenz von 3,0% mit einem Konfidenzintervall (95% KI) von 2,1–4,2, wenn als Bezugsgröße die Teilnehmerzahl benutzt wird, wie dies bisher bei MRSA-Untersuchungen in Altenheimen in Deutschland üblich war. Wird aber der S.-aureus-Anteil von durchweg fast 50% als Bezugsgröße zugrunde gelegt – wie dies bei MRSA-Untersuchungen in Krankenhäusern geschieht –, steigt die MRSA-Prävalenz auf das Doppelte, nämlich auf 6,3% mit einem KI von 4,3–8,8. Das Tragen eines Katheters, insbesondere eines Harnwegskatheters, bedeutet ein fast 3-fach höheres Risiko, einen MRSA zu aquirieren (OR = 2,72, signifikant). Die MRSA-Prävalenz für Harnwegskatheter betrug 11,2% bezogen auf die S.-aureus-positiven Bewohner.The reason for conducting this study in North Rhine-Westphalia was the world-wide increase in MRSA hospital infections leading to the question about the occurrence of MRSA in old people's homes and nursing homes. Between March 2000 and March 2001, 21 community health departments on a voluntary basis collected samples to be examined from a total of 1057 residents of old people's homes and 193 nursing staff members and, together with a completed questionnaire, sent them to the Institute of Public Health (lögd) NRW. In this cross-sectional study 32 residents and one staff member proved positive. This corresponds to a prevalence of MRSA of 3.0% with a confidence interval (95% CI) of 2.1–4.2 if the number of participants is taken for reference as has until now been the usual practice in MRSA examinations in old people's homes in Germany. But if examinations are based on a Staph. aureus proportion of almost 50% as is done in MRSA examinations in hospitals, MRSA prevalence increases to 6.3% with a CI of 4.3–8.8. Catheterization, particularly urinary catheterization, entails an almost three times higher risk of contracting MRSA (OR = 2.72, significant). MRSA prevalence for urinary catheterization was 11.2%, related to the S. aureus-positive residents