First reported case of infective endocarditis caused by community-acquired methicillin-resistant Staphylococcus aureus not associated with healthcare contact in Brazil

We report here the first case of endocarditis due to CA-MRSA not associated with healthcare contact in Brazil in Brazil. A previously healthy patient presented with history of endocarditis following a traumatic wound infection. Patient had multiple positive blood cultures within 72 h of admission and met modified Duke's criterion for infective endocarditis. The isolate was typed as Staphylococcal cassette chromosome (SCC) mec type IV and was positive for presence of Panton-Valentine leukocidin (PVL). Increased incidence of CA-MRSA endocarditis is a challenge for the internist to choose the best empirical therapy. Several authors have suggested an empirical therapy with both a beta-lactam and an anti-MRSA agent for serious S. aureus infections. Our patient was treated with Vancomycin and made complete recovery in 3 months.

Infecciones por Staphylococcus aureus: nuevos retos para un viejo patógeno / Staphylococcus aureus Infections: new challenges from an old pathogen

Staphylococcus aureus es un microorganismo versátil con características virulentas y mecanismos de resistencia diversos a su disposición. En seres humanos también es una causa significativa de una amplia variedad de enfermedades infecciosas. Con frecuencia, S. aureus provoca infecciones profundas que representan una amenaza para la vida, caso de la bacteriemia, endocarditis y neumonía. Aunque tradicionalmente limitado sobre todo a un ámbito hospitalario, en la actualidad S. aureus resistente a meticilina (SARM) está aumentando rápidamente en la comunidad. SARM adquirido en la comunidad es de especial importancia debido a la posibilidad de una propagación descontrolada dentro de las familias y a su propensión a originar infecciones cutáneas y pulmonares de gravedad. A causa del desenlace desfavorable de muchas infecciones SARM mediante el tratamiento de referencia con glucopéptidos, se han introducido nuevos fármacos antimicrobianos pertenecientes a diferentes clases y se han evaluado en ensayos clínicos en busca de su eficacia antimicrobiana en el tratamiento de las infecciones estafilocócicas resistentes. Para contener la diseminación de estas infecciones también se han sugerido una serie de estrategias preventivas. En la presente revisión, abordamos los cambios recientes en la epidemiología de S. aureus y su impacto en las manifestaciones clínicas y tratamiento de las infecciones de gravedad. También describimos las nuevas modalidades de tratamiento de las infecciones por SARM y hacemos hincapié en la importancia de las medidas preventivas (AU)

Staphylococcus aureus is a versatile organism with several virulent characteristics and resistance mechanisms at its disposal. It is also a significant cause of a wide range of infectious diseases in humans. S. aureus often causes life-threatening deep seated infections like bacteremia, endocarditis and pneumonia. While traditionally confined mostly to the hospital setting, methicillin-resistant S. aureus (MRSA) is now rapidly becoming rampant in the community. Community-acquired MRSA is particularly significant because of its potential for unchecked spread within households and its propensity for causing serious skin and pulmonary infections. Because of the unfavorable outcome of many MRSA infections with the standard glycopeptide therapy, new antimicrobial agents belonging to various classes have been introduced and have been evaluated in clinical trials for their efficacy in treating resistant staphylococcal infections. A number of preventive strategies have also been suggested to contain the spread of such infections. In this review, we address the recent changes in the epidemiology of S. aureus and their impact on the clinical manifestations and management of serious infections. We also discuss new treatment modalities for MRSA infections and emphasize the importance of preventive approaches (AU)