Community-associated methicillin-resistant Staphylococcus aureus infections in men who have sex with men: A case series

BACKGROUND: The purpose of the present study was to describe the clinical characteristics and management of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections among a cohort of men who have sex with men. PATIENTS AND METHODS: A retrospective chart review was conducted of patients with culture-proven MRSA at Maple Leaf Medical Clinic (Toronto, Ontario) between November 2004 and December 2005. Cases were identified by individual physicians and by queries in the clinical management system. A standard data collection form was used to record patient demographics, potential risk factors for MRSA and course of illness. When available, antimicrobial sensitivities were recorded. DNA fingerprinting using pulsed-field gel electrophoresis, and genetic analysis for SCCmec typing and detection of the Panton-Valentine leukocidin cytotoxin were performed on six available isolates. RESULTS: Seventeen patients with MRSA infection were identified, 12 (71%) of whom were HIV-positive. The most common clinical presentation was abscess (35%), followed by furuncle (17%), folliculitis (17%), cellulitis (17%) and sinusitis (12%). The majority of MRSA isolates were resistant to ciprofloxacin (92%) and levofloxacin (77%). All isolates were susceptible to trimethoprim-sulfamethoxazole, rifampin, linezolid, gentamicin and clindamycin, while the majority were susceptible to tetracycline (80%). All six isolates tested were SCCmec type IVa-positive and Panton-Valentine leukocidin-positive, and had fingerprint patterns consistent with the CMRSA-10 (USA300) clone. CONCLUSION: The present study describes the clinical presentation and management of CA-MRSA infections occurring in Toronto among men who have sex with men. The infections appear to have been caused by CMRSA-10, which has caused the majority of CA-MRSA outbreaks elsewhere.     

Community-associated methicillin-resistant Staphylococcus aureus endocarditis 'down under': case series and literature review

Infective endocarditis is a common complication of Staphylococcus aureus bacteraemia, but literature reports of community-associated methicillin-resistant S. aureus (CA-MRSA) endocarditis are relatively uncommon and mostly comprise intravenous drug users (IVDUs) with the USA300 strain. We report 5 cases of CA-MRSA endocarditis in previously healthy young Australian adults, 4 in IVDUs. Morbidity was high with frequent septic emboli; 3 patients required cardiac surgery and 1 patient died. Typing revealed the 2 most common Australian strains, the Panton-Valentine leukocidin (PVL)-positive ST93 (Queensland) strain and the PVL-negative ST1 (WA-MRSA-1) strain.     

Community-associated methicillin-resistant Staphylococcus aureus: Reconsideration of therapeutic options

Methicillin resistance, long recognized as characteristic of nosocomial Staphylococcus aureus, has increasingly been identified in community-acquired strains in the past 15 years. The genotypes of community-associated methicillin-resistant S. aureus (MRSA) are different from nosocomial strains, and unlike nosocomial strains, they have a distinctive methicillin-resistance chromosomal cassette (designated type IV), are usually susceptible to multiple classes of antimicrobials other than β-lactams, carry a distinctive virulence factor (the Panton-Valentine leukocidin), cause mainly skin and soft tissue infection and less frequently, necrotizing pneumonia, and involve predominantly children and young adults. Outbreaks have been reported in certain segments of the population (eg, football players, wrestlers, prison inmates, and native people) that often do not have the established risk factors for MRSA. However, these strains have also caused infections likely acquired in an institutional health care setting. Delay in starting appropriate antibiotic therapy for severe infections caused by MRSA can be life-threatening. This requires a reconsideration of the empiric choice of an anti-staphylococcal β-lactam for seriously ill patients with suspected community-associated S. aureus infections.     

Community-associated methicillin-resistant Staphylococcus aureus skin infections: advances toward identifying the key virulence factors

PURPOSE OF REVIEW: In recent years there has been an increase in the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in healthy individuals, the cause of which is largely unknown. CA-MRSA primarily causes skin and soft-tissue infections but certain strains are also associated with unusually severe pathology. The purpose of this review is to provide a critical analysis of our current knowledge of virulence factors contributing to skin and soft-tissue infections caused by CA-MRSA. RECENT FINDINGS: Isolates classified as pulsed-field gel electrophoresis type USA300 have emerged as the predominant CA-MRSA genotype and in most geographic areas account for 97% or more of CA-MRSA infections. Recent key studies, such as those reporting the complete genome sequence of USA300, and the discovery of cytolytic peptides that contribute significantly to CA-MRSA virulence, lead the way for future investigations. SUMMARY: Although we have only a cursory understanding of the molecular mechanisms of CA-MRSA virulence, studies using clinically relevant CA-MRSA isolates are beginning to identify virulence determinants specific to this pathogen. Identifying CA-MRSA virulence determinants and the concerted regulation of these factors will foster development of vaccines and therapeutics designed to control CA-MRSA skin infections.     

Community-associated methicillin-resistant Staphylococcus aureus: current status and molecular epidemiological perspective

MRSA has been a major causative agent of nosocomial infection. However, recently MRSA has become increasingly isolated from community-associated infections. We summarized here up to date information about community-associated MRSA (C-MRSA) infections and characteristics of C-MRSA strains based on molecular analysis. By using the SCCmec typing, strong evidence was provided for the independent derivation of healthcare-associated MRSA and C-MRSA clones.     

Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China

ABSTRACT

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing’s Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β?=??1.37, p?<?.05) and greater endorsement of maladaptive coping (β?=?2.39, p?<?.05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β?=?0.78, p?<?.05), diminished physical health (β?=??0.86, p?<?.05), and a high school or greater level of education (β?=?4.13, p?<?.05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.     

北京市男男性行为者HIV感染及影响因素的调查研究

目的 了解北京市男男性行为者(men who have sex with men,MSM)艾滋病病毒(HIV)感染情况及其影响因素.方法 于2006年9月-2007年2月,在北京市招募MSM进行问卷调查,调查内容包括社会人口学和高危行为学特征,采集血样检测HIV抗体.结果 在所调查的541名MSM中,HIV和梅毒感染率分别为4.8%(26/541)和19.8%(107/541).在多因素Logistic回归模型中,梅毒感染(OR=4.23;95%CI 1.88-9.54)、过去男性性伴总人数≥10个(OR=3.80,95%CI 1.49-9.72)与MSM HIV感染的关系有统计学意义.结论 MSM已成为HIV感染的高危人群之一,有必要加强艾滋病/性病防治知识宣传和预防干预,来降低HIV在MSM中的传播.     

深圳市男男性行为者STD/AIDS感染情况研究

目的了解深圳市男男性行为者(MSM)群体的性传播疾病/艾滋病(STD/AIDS)感染状况。方法在知情同意、匿名自愿的前提下,从男男性行为群体聚集的酒吧、家庭、会所等场所选择研究对象,在现场开展问卷调查、现场体检和实验室标本的采集和检测。结果共调查检测各种文化层次人员182人,平均年龄(20.39±2.80)岁,未婚者占90.5%。其中只有同性性行为者占42.5%,其余均同时与异性有性行为。被调查者与固定性伴发生性行为时每次均使用安全套的比例为49.2%。其中6.7%的人报告曾被诊断有性病。尿道分泌物检查淋球菌阳性率1.68%,衣原体阳性率5.03%。肛门拭子检查淋球菌阳性率2.23%,衣原体阳性率27.93%。血清学检查HIV抗体阳性率0.55%,梅毒阳性率15.39%。结论男男性行为人群性病的感染水平较一般人群高,性生活状态复杂且缺乏安全性意识,是STD/AIDS传播的桥梁人群。     

Community-associated methicillin-resistant Staphylococcus aureus in northwest Ontario: A five-year report of incidence and antibiotic resistance

BACKGROUND:

The incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is traditionally high in remote areas of Canada with large Aboriginal populations. Northwestern Ontario is home to 28,000 First Nations people in more than 30 remote communities; rates of CA-MRSA are unknown.

OBJECTIVE:

To determine the CA-MRSA rates and antibiotic susceptibilities in this region.

METHODS:

A five-year review of laboratory and patient CA-MRSA data and antibiotic susceptibility was undertaken.

RESULTS:

In 2012, 56% of S aureus isolates were CA-MRSA strains, an increase from 31% in 2008 (P=0.06). Reinfection rates have been increasing faster than new cases and, currrently, 25% of infections are reinfections. CA-MRSA isolates continue to be susceptible to many common antibiotics (nearly 100%), particularly trimethoprim/sulfamethoxazole, clindamycin and tetracycline. Erythromycin susceptibility stands at 58%.

DISCUSSION:

Rates of CA-MRSA, as a percentage of all S aureus isolates, were higher than those reported in other primary care series. The infection rate per 100,000 is one the highest reported in Canada. Antibiotic susceptibilities were unchanged during the study period; the 99% susceptibility rate to clindamycin differs from a 2010 Vancouver (British Columbia) study that reported only a 79% susceptibility to this antibiotic.

CONCLUSION:

There are very high rates of CA-MRSA infections in northwestern Ontario. Disease surveillance and ongoing attention to antibiotic resistance is important in understanding the changing profile of MRSA infections. Social determinants of health, specifically improved housing and sanitation, remain important regional issues.     

Sexually transmitted diseases in men who have sex with men: A clinical review

Increases in sexually transmitted diseases (STDs) among men who have sex with men (MSM) have coincided with recent increases in sexual risk behaviors across the United States and Europe. The identification of same-sex sexual risk behavior in men and the subsequent risk for certain bacterial and viral infections requires competency in taking a sexual history. Recent advances in the diagnosis and treatment of STDs have made STD management easier for physicians and patients and expanded the ability of a variety of health care professionals to participate in the management of STDs. This review focuses on recent developments in the epidemiology, pathogenesis, diagnosis, and management of common STDs in MSM.     

Community-associated methicillin-resistant Staphylococcus aureus in a pediatric emergency department in Newfoundland and Labrador

BACKGROUND:

First-generation cephalosporins and antistaphylococcal penicillins are typically the first choice for treating skin and soft tissue infections (SSTI), but are not effective for infections caused by methicillin-resistant Staphylococcus aureus (MRSA). It is currently unclear what percentage of SSTIs is caused by community-associated MRSA in different regions in Canada.

OBJECTIVES:

To determine the incidence of MRSA in children presenting to a pediatric emergency department with SSTI, and to determine which antibiotics were used to treat these infections.

METHODS:

All visits to a pediatric emergency department were reviewed from April 15, 2010 to April 14, 2011. Diagnoses of cellulitis, abscess, impetigo, folliculitis and skin infection (not otherwise specified) were reviewed in detail to determine whether a culture was taken and which antibiotic was prescribed.

RESULTS:

There were 367 cases of SSTI diagnosed over the study period. Forty-five (12.3%) patients had lesions that were swabbed for culture and sensitivity. S aureus was the most common organism found, with 14 (66%) methicillin-sensitive cases and seven (33%) methicillin-resistant cases. Of the seven cases of MRSA identified, only one patient had clear risk factors for hospital-acquired MRSA. First-generation cephalosporins were initially prescribed for 280 (76%) patients.

CONCLUSIONS:

The overall incidence of MRSA in the population presenting to a pediatric emergency department in Newfoundland and Labrador appeared to be low, although only a small percentage of infections were cultured. At this time, there appears to be no need to change empirical antibiotic coverage, which remains a first-generation cephalosporin.