Skin and Soft-Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus

A 37-year-old man presents for the evaluation of localized swelling and tenderness of the left leg just below the knee. He suspects this lesion developed after a spider bite, although he did not see a spider. Examination of the leg reveals an area of erythema and warmth measuring approximately 5 by 7 cm. At the center of the lesion is a fluctuant area measuring approximately 2 by 2 cm, overlaid by a small area of necrotic skin. The man’s temperature is 38.3°C. The pulse rate is 115 beats per minute. The blood pressure is 116/78 mm Hg. How should this patient be evaluated and treated?

[1]  B. Markey,et al.  Meticillin-resistant Staphylococcus aureus in animals: a review. , 2008, Veterinary journal.

[2]  D. Skiest,et al.  Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. , 2007, The Journal of infection.

[3]  D. Holmes,et al.  Stepwise Exposure of Staphylococcus aureus to Pleuromutilins Is Associated with Stepwise Acquisition of Mutations in rplC and Minimally Affects Susceptibility to Retapamulin , 2007, Antimicrobial Agents and Chemotherapy.

[4]  E. Delong,et al.  Staphylococcus aureus Panton-Valentine Leukocidin Causes Necrotizing Pneumonia , 2007, Science.

[5]  B. Diep,et al.  Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  J. Patel,et al.  High Frequencies of Clindamycin and Tetracycline Resistance in Methicillin-Resistant Staphylococcus aureus Pulsed-Field Type USA300 Isolates Collected at a Boston Ambulatory Health Center , 2007, Journal of Clinical Microbiology.

[7]  Loren G. Miller,et al.  Community-associated Methicillin-resistant Staphylococcus aureus Isolates and Healthcare-Associated Infections , 2007, Emerging infectious diseases.

[8]  Adeline R. Whitney,et al.  Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease? , 2006, The Journal of infectious diseases.

[9]  K. Mayer,et al.  Treatment and Outcomes of Infections by Methicillin-Resistant Staphylococcus aureus at an Ambulatory Clinic , 2006, Antimicrobial Agents and Chemotherapy.

[10]  S. Kaplan,et al.  Infective pyomyositis and myositis in children in the era of community-acquired, methicillin-resistant Staphylococcus aureus infection. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Guiqing Wang,et al.  Increased Vancomycin MICs for Staphylococcus aureus Clinical Isolates from a University Hospital during a 5-Year Period , 2006, Journal of Clinical Microbiology.

[12]  Roberta B Carey,et al.  Methicillin-resistant S. aureus infections among patients in the emergency department. , 2006, The New England journal of medicine.

[13]  Vance G Fowler,et al.  Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. , 2006, The New England journal of medicine.

[14]  G. Stein,et al.  Tigecycline: a critical analysis. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  E. Larson,et al.  Meticillin-resistant Staphylococcus aureus among US prisoners and military personnel: review and recommendations for future studies. , 2006, The Lancet. Infectious diseases.

[16]  S. Kaplan,et al.  Venous Thrombosis Associated With Staphylococcal Osteomyelitis in Children , 2006, Pediatrics.

[17]  G. Sensabaugh,et al.  Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus , 2006, The Lancet.

[18]  J. Powers,et al.  Strategies for Clinical Management of MRSA in the Community: Summary of an Experts' Meeting Convened by the Centers for Disease Control and Prevention , 2006 .

[19]  Ronald N. Jones,et al.  Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. , 2006, Diagnostic microbiology and infectious disease.

[20]  J. Fergie,et al.  Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children's Hospital. , 2005, Archives of pediatrics & adolescent medicine.

[21]  S. Boyle-Vavra,et al.  Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children. , 2005, The New England journal of medicine.

[22]  Chih-Chien Wang,et al.  Successful Multiresistant Community-Associated Methicillin-Resistant Staphylococcus aureus Lineage from Taipei, Taiwan, That Carries Either the Novel Staphylococcal Chromosome Cassette mec (SCCmec) Type VT or SCCmec Type IV , 2005, Journal of Clinical Microbiology.

[23]  J. Sarria,et al.  Clinical characteristics of linezolid-resistant Staphylococcus aureus infections. , 2005, The American journal of the medical sciences.

[24]  K. Edwards,et al.  Increasing Rates of Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in Healthy Children , 2005, The Pediatric infectious disease journal.

[25]  L. Mortin,et al.  Inhibition of daptomycin by pulmonary surfactant: in vitro modeling and clinical impact. , 2005, The Journal of infectious diseases.

[26]  J. Versalovic,et al.  Three-year surveillance of community-acquired Staphylococcus aureus infections in children. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[27]  J. Ruhe,et al.  Use of long-acting tetracyclines for methicillin-resistant Staphylococcus aureus infections: case series and review of the literature. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  P. Simon,et al.  Risk factors for community-associated methicillin-resistant Staphylococcus aureus skin infections among HIV-positive men who have sex with men. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  R. Lynfield,et al.  Methicillin-resistant Staphylococcus aureus disease in three communities. , 2005, The New England journal of medicine.

[30]  Brad Spellberg,et al.  Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. , 2005, The New England journal of medicine.

[31]  P. Schlievert,et al.  Purpura fulminans due to Staphylococcus aureus. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  Arjun Srinivasan,et al.  A clone of methicillin-resistant Staphylococcus aureus among professional football players. , 2005, The New England journal of medicine.

[33]  J. Macia,et al.  Treatment failure of methicillin-resistant Staphylococcus aureus endocarditis with linezolid , 2005, Scandinavian journal of infectious diseases.

[34]  A. Hidrón,et al.  Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  D. Hospenthal,et al.  Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[36]  H. Harris,et al.  An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients. , 2004, Archives of surgery.

[37]  Xiao Xue Ma,et al.  Novel Type V Staphylococcal Cassette Chromosome mec Driven by a Novel Cassette Chromosome Recombinase, ccrC , 2004, Antimicrobial Agents and Chemotherapy.

[38]  S. Iyer,et al.  Community-acquired methicillin-resistant Staphylococcus aureus skin infection: a retrospective analysis of clinical presentation and treatment of a local outbreak. , 2004, Journal of the American Academy of Dermatology.

[39]  L. Mermel,et al.  Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children. , 2004, Pediatrics.

[40]  M. Swartz,et al.  Clinical practice. Cellulitis. , 2004, The New England journal of medicine.

[41]  A. Mejias,et al.  Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus , 2004, The Pediatric infectious disease journal.

[42]  Susan K. Johnson,et al.  Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. , 2003, JAMA.

[43]  R. Wunderink,et al.  Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. , 2003, Chest.

[44]  S. McAllister,et al.  Pulsed-Field Gel Electrophoresis Typing of Oxacillin-Resistant Staphylococcus aureus Isolates from the United States: Establishing a National Database , 2003, Journal of Clinical Microbiology.

[45]  R. Daum,et al.  Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[46]  F. Vandenesch,et al.  Community-Acquired Methicillin-Resistant Staphylococcus aureus Carrying Panton-Valentine Leukocidin Genes: Worldwide Emergence , 2003, Emerging infectious diseases.

[47]  S. Kaplan,et al.  Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children , 2003, The Pediatric infectious disease journal.

[48]  D. Ledoux,et al.  Occurrence of MRSA Endocarditis During Linezolid Treatment , 2003, European Journal of Clinical Microbiology and Infectious Diseases.

[49]  M. Moore,et al.  Vancomycin Treatment Failure Associated with Heterogeneous Vancomycin-Intermediate Staphylococcus aureus in a Patient with Endocarditis and in the Rabbit Model of Endocarditis , 2003, Antimicrobial Agents and Chemotherapy.

[50]  R. Wunderink,et al.  Drotrecogin Alfa (activated) Improves In-hospital and 90-day Survival in Patients With Severe Sepsis and Community-acquired Pneumoni , 2003 .

[51]  Teruyo Ito,et al.  A novel methicillin-resistance cassette in community-acquired methicillin-resistant Staphylococcus aureus isolates of diverse genetic backgrounds. , 2002, The Journal of infectious diseases.

[52]  J. Quinn,et al.  Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children , 2002, The Pediatric infectious disease journal.

[53]  P. Vanhems,et al.  Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients , 2002, The Lancet.

[54]  Amy V. Groom,et al.  Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. , 2001, JAMA.

[55]  H. Chambers,et al.  The changing epidemiology of Staphylococcus aureus? , 2001, Emerging infectious diseases.

[56]  H Stammer,et al.  Nasal Carriage as a Source of Staphylococcus aureus Bacteremia , 2001 .

[57]  H. Fineberg,et al.  The Changing Epidemic , 2001 .

[58]  Frances B. Jamieson,et al.  Methicillin-Resistant Staphylococcus aureus Carriage in a Child Care Center Following a Case of Disease , 1999 .

[59]  T. Murphy,et al.  Methicillin-resistant Staphylococcus aureus in two child care centers. , 1998, The Journal of infectious diseases.

[60]  D. Lauderdale,et al.  Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. , 1998, JAMA.

[61]  L. Saravolatz,et al.  Trimethoprim-Sulfamethoxazole Compared with Vancomycin for the Treatment of Staphylococcus aureus Infection , 1992, Annals of Internal Medicine.

[62]  L. Strausbaugh,et al.  Antimicrobial Therapy for Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff of a Veterans Affairs Nursing Home Care Unit , 1992, Infection Control & Hospital Epidemiology.