Correspondence
Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection
N Engl J Med 1993; 329:1896December 16, 1993
- Article
To the Editor:
We report a community-acquired methicillin-resistant Staphylococcus aureus infection in a 65-year-old woman who did not use intravenous drugs and was not a nursing home resident. The patient was hospitalized with endocarditis due to methicillin-resistant S. aureus. Neither she nor her husband had been hospitalized for the past 15 years. They had not visited a nursing home. No family members worked in a health care facility, and none used intravenous drugs. She became deaf, quadriplegic, and aphasic as a result of the infection and its treatment.
Cells for culture were obtained from the hands, nose, and throats of family members, including the husband, two daughters, and two grandchildren. Methicillin-resistant S. aureus was isolated from the nose of a five-year-old grandson, who lived one block away. Six months later methicillin-resistant S. aureus was again isolated from the grandson. It was not found 18 months later.
The organisms were studied at the New York City Public Health Research Institute Department of Microbiology Center. The isolates were resistant only to methicillin, in contrast to methicillin-resistant S. aureus strains found in hospitals in the New York area, which have multidrug resistance. The isolates were compared with two gene probes, mec and Tn554, previously used to catalogue 450 isolates of methicillin-resistant S. aureus1. The DNA patterns of the two strains and the mec:Tn554 classification of II:NH (indicating type II mec and no homology to Tn554) were strikingly different from those of the hospital isolates observed since the early 1980s. The II:NH pattern was commonly observed among “old” isolates, and these strains, like our isolates, were most often sensitive to other antibiotics.
Community-acquired methicillin-resistant S. aureus infection was reported in Detroit in 1982, mainly among intravenous drug users2. There have been few cases among persons who are not intravenous drug users; most such patients had been recently hospitalized. There have also been reports of infection and colonization among nursing home residents3,4.
This strain appears to be similar to that described among intravenous drug users,5 in that its resistance is limited to methicillin. Community-acquired strains may be exposed predominantly to beta-lactam antibiotics, which may explain this pattern of resistance. The pattern of multidrug resistance that characterizes the nosocomial strains may be a result of the exposure of S. aureus to multiple antibiotics.
We do not know the extent of colonization with methicillin-resistant S. aureus in the community. We hope that this case is an isolated one.
5 ReferencesDaniel S. Berman, M.D.
Westchester Square Medical Center, Bronx, NY 10461William Eisner
Barry Kreiswirth, Ph.D.
Public Health Research Institute, New York, NY 100161
Kreiswirth B ,Kornblum J ,Arbeit RD , et al. Evidence for a clonal origin of methicillin resistance in Staphylococcus aureus. Science 1993;259:227-230
CrossRef | Web of Science | Medline2
Saravolatz LD ,Markowitz N ,Arking L ,Pohlod D ,Fisher E . Methicillin-resistant Staphylococcus aureus: epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982;96:11-16
Web of Science | Medline3
Muder RR ,Brennen C ,Wagener MM , et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107-112
Web of Science | Medline4
Bradley SF ,Terpenning MS ,Ramsey MA , et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417-422
Web of Science | Medline5
Berman DS, Holzman R, Della-Latta P, et al. Epidemiology of community acquired methicillin-resistent S. aureus in intravenous drug abusers. Presented at the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, September 28-October 1, 1986. abstract.
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Robert S. Daum, John B. Seal. (2001) Evolving antimicrobial chemotherapy for Staphylococcus aureus infections: Our backs to the wall. Critical Care Medicine 29:Supplement, N92-N96
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J. H. T. Wagenvoort, H. M. J. Toenbreker, A. Nurmohamed, B. I. Davies. (1997) Transmission of methicillin-resistantStaphylococcus aureus within a household. European Journal of Clinical Microbiology & Infectious Diseases 16:5, 399-400
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