[Outpatient management of community acquired meticillin resistant Staphylococcus aureus (MRSA) in Belgium].

Meticillin resistance is observed among S.aureus strains since 1961 and is due to the synthesis by S.aureus of a modified penicillin binding proteins named PBP2a with decreased affinity to Meticillin. Meticillin-resistant S.aureus (MRSA) strains are resistant to all betalactam antibiotics except Ceftaroline. Three epidemiological type of MRSA are now described globally in Europe and certainly in Belgium. These different types of MRSA differ by their genetic composition, the presence of virulence factors, their transmissibility, their clinical picture and their sensitivity to ant ibiot ics. The first one are the hospi tal associated MRSA strains (HA-MRSA) that causes pneumonia, urinary tract infection or bacteremia mostly among old patients presenting multiple comorbidities. Multiresistance to antibiotics is frequent in HA-MRSA and treatment of HA-MRSA related infections usually necessitate hospitalization of the patient. The second type of MRSA is a livestock associated MRSA (LA-MRSA). At risk persons are person living in close contact to livestock as farmers and veterinarians). The third type of MRSA is the community associated MRSA (CA-MRSA) described among individuals with little or no exposure to healthcare facilities. CAMRSA has been recognized in Belgium since 2003. In more than 80 % of cases, it is responsible for skin and soft tissue infections such as abscesses, furuncles and purulent cellulitis in otherwise healthy individuals. A great proportion of the CA-MRSA strains carry the Panton- Valentine leukocidin gene, a severity factor of S.aureus infections. In Belgium up to 6 % of acute skin and soft tissue are due to CA-MRSA. Recurrent infections and transmission among household members are frequently described. Incision and drainage is the primary treatment of CA-MRSA associated abscesses. Antibiotic therapy is recommended only in patient with severe infect ions or with underlying comorbidities. CA-MRSA is usually susceptible to non betalactam antibiotics. Recommended antibiotics, if antibiogram shows the strain is suceptible to the drug, are clindamycin, doxycycl in and cotrimoxazole. Prevent ive educational messages on personal hygiene and appropriate wound care will complete the medical treatment. Decolonisation of the patient and the household members can be performed in case of recurrent lesions and/or dissemination among the family. Outbreak of CA-MRSA infections must be reported to the health inspector.