Journal
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY
Volume 65, Issue 3, Pages 219-225Publisher
AMER SOC HEALTH-SYSTEM PHARMACISTS
DOI: 10.2146/ajhp060637
Keywords
antiinfective agents; methicillin; penicillins; resistance; staphylococcal infections; Staphylococcus aureus
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Purpose. Risk factors and treatment recommendations for community-associated methicillin-resistant Staphylococcus aureus are reviewed. Summary. A new strain of methicillin-resistant Staphylococcus aureus (MRSA) has prompted researchers to examine the factors associated with infections acquired in outpatient settings as opposed to those that develop nosocomially. Infections of the skin, lungs, urinary tract, and bloodstream diagnosed within 24-72 hours of hospitalization and with no risk factors present were categorized as community-associated MRSA (CA-MRSA) and differentiated from health-care-associated methicillin-resistant S. aureus (HA-MRSA) on a molecular basis. Pulsed-field electrophoresis has been instrumental in genotyping the S. aureus organism to identify bacterial isolates. Molecular differences between community- and hospital-associated strains show that the organisms were geneticaliy distinct and had not migrated to other settings. Some studies examining antibiotic resistance indicated a steady increase in the rate of MRSA infections. In addition, results of a 15-year longitudinal study indicated significant increases in CA-MRSA-positive isolates between 1991 and 2004. Race, age, sex, hygiene, living environment, and socioeconomic status have been shown to play a key role in the incidence of CA-MRSA. Conclusion. Health care providers should recognize how CA-MRSA and HA-MRSA are differentiated and what factors are associated with infections caused by the organisms. This will enable health care providers to quickly identify and initiate appropriate treatment for these infections.
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