Kawabata Hidenobu, Murakami Manabu, Kisa Kengo, Kimura Yuya, Maezawa Masaji
Department of Healthcare Systems Research, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Rural Med. 2010;5(1):140-3. doi: 10.2185/jrm.5.140.
Infections caused by methicillin-resistant Staphylococcus Aureus (MRSA) have recently occurred in communities in people lacking known healthcare risk factors. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection, and is distinct from hospital-associated MRSA infection, which occurs in people with risk factors. We experienced a patient diagnosed with CA-MRSA cellulitis, as culture of pus revealed MRSA and he had not been exposed to healthcare environments for the past year. The patient was a previously healthy 38-year-old man with suppurative cellulitis in his right index finger following injury to the finger at his worksite. The cellulitis was successfully managed with incision and drainage (I&D), followed by cefazolin during a 10-day clinical course, although the patient's MRSA strain was resistant to cefazolin. There are several reports that suggest that I&D followed by antibiotic treatment for CA-MRSA skin infection produces equivalent clinical outcomes, whether the antibiotic prescribed was effective or not. Given that MRSA emerged in an outpatient setting, CA-MRSA should be considered a possible etiology of skin infection in healthy individuals with no classical risk factors for acquisition of MRSA.
耐甲氧西林金黄色葡萄球菌(MRSA)引起的感染最近在没有已知医疗保健风险因素的社区人群中出现。这种MRSA感染被称为社区相关性MRSA(CA-MRSA)感染,与医院相关性MRSA感染不同,后者发生在有风险因素的人群中。我们遇到了一名被诊断为CA-MRSA蜂窝织炎的患者,因为脓液培养显示为MRSA,且他在过去一年中未接触过医疗环境。该患者是一名此前健康的38岁男性,在工作场所手指受伤后,右手食指出现化脓性蜂窝织炎。尽管患者的MRSA菌株对头孢唑林耐药,但通过切开引流(I&D),随后在10天的临床病程中使用头孢唑林,蜂窝织炎得到了成功治疗。有几份报告表明,对于CA-MRSA皮肤感染,无论所开抗生素是否有效,切开引流后进行抗生素治疗都会产生相当的临床效果。鉴于MRSA在门诊环境中出现,CA-MRSA应被视为没有获得MRSA经典风险因素的健康个体皮肤感染的可能病因。