mrsa
TRANSCRIPT
MRSA
. ’
. « »
EARS-Net 2010
European trends forresistance tomethicillin
EARS-Net 2010
MRSA timeline
1940 1950 1960 1970 1980 1990 2000 2010
MRSA
CA-MRSA
CA-MRSA HA-MRSA
HA-MRSA CA-MRSA
. )
pvl + (<5%) (>95%)
SCCmec I,II IV, V
HA vs CAMRSA
• MSM
CA-MRSA CA-MRSA
Deresinski S. Clin Infect Dis 2005
CA-MRSA CO-MRSA
Community Acquired
Community Associated
Community Onset
CA-MRSA(CDC)
< 48 MRSA
• Pulsed Field Gel Electrophoresis - PFGE• Multi-Locus Sequence Typing – MLST• SCC-mec• pvl• spa typing
* MLST SCCmec . ST8-SCCmecIV
, )
1. mecA +2. (CDC)3.
4.5. SCCmecIV-V
1-5 CA-MRSA1,3,5 MRSA
Staphylococcal Chromosome CassetteSCCmec
CA-MRSA
DeLeo FR. Lancet 2010
CA-MRSA
• ST-30 SCCmecIV 1993 ST80-
SCCmecIV 1998
• ST-80 pvl+
Aires de Sousa M. H J Clin Microbiol 2003
CA-MRSA
MRSA
MRSA
MSSA
no colonization
SCCmec type
IVa IVc IVe IVNT V II IIIA NT Total
pvl-pos 33 2 1 36
pvl-neg 3 15 4 3 3 28
• 2994
• 2006-2008
• 88 (2.9%) MRSA
• 388 (13%) MSSA
Pliarchopoulou F. ECCMID 2008
MRSA
: 0/2961. : <1%
.: 1.5%– 3898 : 1.8%– 4452 : 0.76%
: 0.2%
Gorwitz RJ. J Infect Dis 2008
Grundmann H. BMJ 2002
Donker GA. Clin Microbiol Infect 2009
Salgado CD. Clin Infect Dis 2002
MRSA colonization –No (%)
PUnivariateanalysis
PMultivariate analysis
OddsRatio
Yes NoGender (male) 33 (2.5) 55 (3.3) >0.1Age < 65 72 (3.2) 16 (2.2) >0.1Children at nursery 4 (2.4) 84 (3) >0.1Children at school 16 (4.4) 72 (2.8) 0.1 NSHospitalization inprevious year
20 (2.2) 68 (3.3) 0.8 NS
Long term care facility 6 (18.8) 82 (2.8) <0.001 <0.001 12.05Antibiotics in previoussix months
36 (3.2) 52 (2.8) >0.1
Skin disease 26 (7.1) 62 (2.4) <0.001 <0.001 3.06Immunosuppression 11 (2.2) 77 (3.1) >0.1Smoking 32 (3.4) 56 (2.8) >0.1Diabetes mellitus 7 (1.7) 81 (3.2) 0.06 NSChronic renal failure 1 (1.1) 87 (3.0) >0.1Dialysis 0 88 (3.0) >0.1Indwelling urinarycatheter
7 (4.5) 81 (2.9) >0.1
Hypertension 14 (2.3) 74 (3.1) >0.1Obstructive lungdisease
2 (1.9) 86 (3.0) >0.1
Oxacillin
Ciprofloxacin
Clindam
ycin
Fusidic acid
Gentam
ycin
Linezolid
Minocycline
Moxifloxacin
Rifam
pin
TMP/SM
X
Vancomycin
Resistant(%)
88(100)
21(24)
29(33)
47(53)
12(14)
0(0)
5(6)
17(19)
6(7)
8(9)
0(0)
MRSA
N PVL ST SCCmec spa Cp E Cl F Co G T Rif
1 + 80 IV t044 S S S R S S R S
2 + 80 IV t044 S S S R S S R S
3 + 80 IV t044 S S S R S S R S
4 + 80 IV t044 S S S R S S R S
5 + 80 IV t044 S S S R S S R S
6 + 80 IV t044 S R R R S S R S
7 + 80 IV t131 R R R R S S R S
8 + 30 IV t8026 S S S S S S S S
11 - 239 III t421 R R R R R S R S
12 - 22 IV t005 S S S S S S S S
13 - 30 IV t8767 S S S S S S S S
15 - 105 II t002 R R R R S S S S
17 - 5 II t002 R R R S R S S S
18 - 5 II t002 R R R S R S S S
19 - 239 III t1152 R R R R R R R S
.
959
9 (<1%) MRSA
8 ST-30 1 ST-80
Karapsias S. Eurosurveill 2008
151 23 )
Staph aureus 34 (22.5%)
MRSA 5 (3.3%)
• 3/5 OXA/TET/FUS/COT
CA-MRSA
CA-MRSA
• 2006-7. « »
286
Staph. aureus88 (30.8%)
MRSA27 (30.7%)
sccMEC IV
pvl +
MLST: ST-80
Vourli S. Eurosurveillance 2009
tet R, fus R, cotr S, FQ S, clind S
7
9
6
4
1
CA-MRSA
170 Staph. aureus106 (62%) MRSA99 PVL – ST80
75 SSTI 31
Sdougkos G. Clin Microbiol Infect 2008
198 Staph. aureus
88 (44%) MRSA
73% SSTI
28 (68%) PVL+, SCCmecIV
CA-MRSA
Niniou I. Eur J Clin Microb Infect Dis 2008
Niniou I. Eur J Clin Microb Infect Dis 2008
Niniou I. Eur J Clin Microb Infect Dis 2008
Niniou I. Eur J Clin Microb Infect Dis 2008
pvl+ MRSA
Chini V. Clin Microbiol Infect 2005
25% MRSA
ST80-SCCmecIV
1058
3
CA-MRSA
• 8 (3 – 37.5%)
• SCCmecIV ST80
-
Maltezou HC. Int J Infect Dis 2009
CA-MRSA
pvl+
– ARDS –
Kefala-Agoropoulou. Eur J Pediatr 2010
Balis E. J Chemother 2007
Magira EE. Scand J Infect Dis. 2007
Michalopoulos A. Pneumon 2008
LA-MRSA
• Livestock associated MRSA• ST398
Graveland. Int J Med Microbiol 2011
: ;
CA-MRSA
: ;
– ±
Liu C. IDSA Guidelines. Clin Infect Dis 2011
CA-MRSA
ST80-SCCmecIV-pvl+
