Vancomycin-resistant Enterococcus faecium osteoarthritis following Staphylococcus aureus hip infection.
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Wide spread of MRSA infection in geriatric hospitals indicated two important problems which must be resolved. One is how we can eradicate MRSA in the elderly, and the other is how we can control cross infections of MRSA within the hospital. The presence of infected decubital ulcers in the elderly make it difficult to answer these problems. Usually, MRSA and Pseudomonas aeruginosa which is isolated from decubital ulcers act as colonizers on the surface of granulated wounds but do not contribute to clinical symptoms. However, these colonizers can be the source of cross infection toward other debilitated patients. The actual management for decubital ulcer infected by MRSA are discussed from the above viewpoints.
The case of a 49-year-old male Caucasian, with more than a 3-year history of recurrent keratoconjunctivitis treated with steroids, antibiotics and midriatics, is reported. A combined Acremonium spp. and S. aureus infection was detected. After unsuccessful therapy with fluconazole, the Acremonium spp. infection was eradicated by voriconazole treatment. To our knowledge, this is the first case report of complete regression of this kind of infection by the use of voriconazole. Therefore, we strongly recommend, in the event of a compatible clinical picture, laboratory testing for mycetes even in the absence of traumatic events, and the use of the new generation azoles, in order avoid a keratoplasty intervention and disease progression to severe endophthalmitis.
We have examined background factors in MRSA infection in cases in which S. aureus had been isolated from sputa. The incidence of isolation of S. aureus was high and still increasing in expectorated sputa, and causative organisms in the cases of pneumonia and autopsied lungs. A significant correlation was observed between high incidence of isolation of S. aureus and abuse of third-generation cephems. MRSA isolation rates of inpatients was higher than that of outpatients. Among the inpatients such cases with severe underlying diseases and prolonged admission showed the highest incidence of isolation of MRSA. There seemed to be a correlation between distribution of patients with S. aureus and that of rooms with S. aureus in the air. This suggests nosocomial infection. Although MRSA was frequently isolated from sputa, most cases showed no signs of infection, and this suggested that they had been transient colonization. Such antimicrobial agents as rifampicin, teicoplanin, vancomycin reveal excellent antibacterial activity against MRSA and minocycline, ofloxacin were moderately effective. The physician must be informed of the significance of MRSA, because their understanding of MRSA still remains insufficient.
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During 1999-2003 in a Saudi Arabian Hospital, methicillin-resistant Staphylococcus aureus constituted 6% of all S. aureus isolates; the proportion had increased from 2% in 1999, to 9.7% in 2002, to 8% in 2003. Of all MRSA isolates, 62% represented community-acquired infection, 20.4% represented healthcare-associated infection, and 17.6% represented nosocomial infection. The proportion of community-acquired isolates increased from 41.7% in 1999 to 66.6% in 2002, and the proportion representing nosocomial infection decreased from 33% in 1999 to 19% in 2003. Isolates representing nosocomial infection showed higher rates of resistance to ciprofloxacin (76.6%), clindamycin (76.6%), erythromycin (68%) and trimethoprim-sulfamethoxazole (68%) than did isolates in the other categories (P<.001).