A report on intraspinal abscess due to community-acquired methicillin-resistant Staphylococcus aureus infection

To the Editor: The incidence of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection and reports of CA-MRSA infection have been increasing yearly. But community-acquired intraspinal methicillin-resistant Staphylococcus aureus (MRSA) infection has never been reported. We describe a case of intraspinal abscess due to CA-MRSA infection.

A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India

Objective:To investigate the infection of hospital-and community-acquired"erythromycininduced clindamycin resistant"strains or D-test positives of clinical isolates of Staphylococcus aureus(S.aureus)(with and without methicillin resistance)in a hospital.Methods:Strains of S.aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling.Results:Of the total 278 isolates,140(50.35%)were D-test positives and the rest were D-test negatives.Further,of 140(100%)pesitives,87(62.14%)and 53(37.85%)strains were from males and females,respectively.Of 140(100%)pesitives,117(83.57%)were methicillin resistant S.aureus and23(16.42%)were methicillin sensitive S.aureus;of 140 strains,103(73.57%)strains front persons with and 37(26.42%)were without related infections;of 140 strains,91(65%)and 49(35%)were from hospital-and community-acquired samples,respectively.In 140 strains,118(84.28%)with comorbidities and 22(15.71%)without comorbidities cases were recorded;similarly,persons with prior antibiotic uses contributed 108(77.14%)and without 32(22.85%)positive strains.These binary data of surveillance were analyzed by a univariate analysis.It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity,corroborated by low P values,P=0.001 1 and 0.0024,respectively.All isolates(278)were resistant to17 antibiotics of nine groups,in varying degrees;the minimum of 28%resistance for vancomycin and the maximum of 97%resistance for gentamicin were recorded.Further,of 278 strains,only42(15.1%)strains were resistant constitutively to both antibiotics,erythromycin resistant and clindamycin resistant,while 45(16.2%)strains were constitutively sensitive to both antibiotics(erythromycin sensitive,and clindamycin sensitive).Further,of the rest 191(68.7%)strains were with erythromycin resistant and clindamycin resistant,of which only 140(50.35%)strains were D-test positives,while the rest 51(18.34%)strains were D-test negatives.Conclusions:In view of high prevalence of D-test positive S.aureus strains,and equally high prevalence of multidrug resistant strains both in community and hospital sectors,undertaking of D-test may be routinely conducted for suppurative infections.

Intervention points for community- acquired methicillin- resistant Staphylococcus aureus colonization and load in healthy population of lesser Himalayan Belt, South Asia, India

OBJECTIVES： To trace the critical practicing, clinical and epidemiological risk factors in bacterial load and points of intervention in spread of community-acquired methicillin resistant Staphylococcus aureus （CA-MRSA） in healthy community. STUDY DESIGN： 2872 individuals with no prominent clinical features were enrolled and administered a pre-tested questionnaire prepared on the basis of outcome of a prior pilot study in same region. Swab samples from skin, throat and nasal nares were tested for MRSA and molecular identification was done to track the strains moving from hospital to community. METHODS： Swab samples from skin, throat and nasal nares were tested for MRSA culture followed by molecular characterization of isolates and antimicrobial resistance pattern. Bacterial load was estimated to better understand the burden in different categories. Statistical analysis was done using SPSS 16.0 version. RESULTS： History of prior infection （OR 3.9, 95% CI 1.363 - 5.793）, habit of self remedy （OR 3.2, 95% CI 0.991 1.473） and incomplete treatment （OR 0.26, 95% CI 0.08 - 0.80） （P 〈 0.05 for each） were the predominant factors that contributed to spread of CA-MRSA. Increased drug resistance in CA-MRSA was observed for 4 different clones： SCCmec^＋ IVa/PVL^＋, SCCmec^＋ IVa/PVL^- and SCCmec^＋ IVc/PVL^＋, SCCmec^＋ IVc/PVL . Bacterial load was found significantly high in below poverty line dwellers and drug abusers （P 〈 0.05）. CONCLUSION： We identified habit of self remedy, drug abusing and incomplete treatment as practicing risk factors where interventions can be made to manage the dissemination of CA-MRSA in rural population.