Atypical pneumonia linked to community-acquired staphylococcus aureus cross-transmission in the nursery.

We report the observation of a necrotizing pneumonia due to methicillin-resistant Staphylococcus aureus harboring the Panton-Valentine leukocidin-encoding gene in a previously healthy neonate, with favorable clinical outcome in spite of extensive radiologic lesions. The case was linked to a cluster of 3 neonates colonized by Panton-Valentine leukocidin-producing, methicillin-resistant S. aureus through cross-transmission in the nursery, underlining the need to comply with standard infection control precautions in the maternity ward.

Relationship between nasal colonization and ventilator-associated pneumonia and the role of the environment in transmission of Staphylococcus aureus in intensive care units.

BACKGROUND: This study assessed the relationship between nasal colonization and ventilator-associated pneumonia (VAP) by Staphylococcus aureus, as well the role of the environment in the transmission of this organism. METHODS: We performed a cohort study of patients with VAP caused by methicillin-resistant S aureus (MRSA) or methicillin-sensitive S aureus during 2 years in an adult intensive care unit (ICU). All patients had nasal swab specimens obtained at admission and during the ICU stay. Clinical samples also were collected for analysis, as were samples from the hands of health care professionals and the environment, and were typed using pulsed-field gel electrophoresis. RESULTS: S aureus VAP represented 12.5% of the cases, and statistical analysis identified colonization as a risk factor for the development of this infection. MRSA was isolated from the environment and hands, indicating the existence of a secondary reservoir. Molecular typing revealed a polyclonal profile; however, clone J was the most frequent (45.5%) among isolates of MRSA tested, with a greater profile of resistance than the other isolates. There was strong evidence suggesting transmission of MRSA to patients from the environment. CONCLUSION: Nasal colonization for S aureus is a risk factor for development of VAP.

Evidence of transmission of a Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus clone: a family affair.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) may represent a serious public health problem, owing to the spread of toxin-producing lineages. The presence of genes encoding for Panton-Valentine leukocidin (PVL) is an important virulence marker, as the clinical sequelae of PVL-positive infections are often described as more severe than those of PVL-negative S. aureus infections. To date, the presence of PVL has not appeared to be common in Italy; we describe the intrafamilial transmission of an epidemic PVL-producing CA-MRSA lineage, Southwest Pacific clone (SWP). Our data suggested that the strain circulated from the father, who was recurrently affected by a soft tissue infection, to the mother, who showed nasal colonization, and to their child, who was hospitalized with symptoms of necrotizing pneumonia. In this case, we found that a recurrent skin infection that is not normally taken into account may represent a serious threat if caused by a PVL-producing strain. Our findings may have considerable implications for strategies for infection control and treatment of methicillin-resistant S. aureus infections.

A severe pneumonia due to methicillin resistant staphylococcus aureus clone USA 300: implications of vertical transmission.

Staphylococcus aureus is an important pathogen in both community and healthcare associated pneumonia. We describe a case of severe pneumonia caused by the methicillin resistant Staphylococcus aureus (MRSA) clone USA 300 in a 44-year old post-partum woman and the subsequent vertical transmission of this virulent organism to her neonate.

A severe pneumonia due to methicillin resistant Staphylococcus aureus clone USA 300: implications of vertical transmission / Pulmonía severa debido al clon USA 300 del estafilococo dorado resistente a la meticilina: implicaciones de la transmisión vertical

Staphylococcus aureus is an important pathogen in both community and healthcare associated pneumonia. We describe a case of severe pneumonia caused by the methicillin resistant Staphylococcus aureus (MRSA) clone USA 300 in a 44-year old post-partum woman and the subsequent vertical transmission of this virulent organism to her neonate.

El estafilococo dorado (Staphylococcus aureus) es un patógeno importante tanto en la atención a las comunidades como en el cuidado de la salud en relación con la pulmonía. Se describe un caso de pneumonia severa causada por el clon USA 300 del estafilococo dorado resistente a la meticilina (EDRM) en una mujer de 44 anos en periodo de post-parto, y la posterior transmisión vertical de este virulento organismo a su neonato.

[Intrafamilial transmission of Staphylococcus aureus Panton-Valentine leukocidin responsible for two cases of neonatal necrotizing pneumonia]. / Transmission intrafamiliale de Staphylococcus aureus sécréteur de toxine leucocidine Panton-Valentine responsable de deux cas de pneumopathies nécrosantes néonatales.

Necrotizing Staphylococcus aureus Panton-Valentine leukocidin (SA-PLV+) accounts for less than 1% of community-acquired lung diseases in children and young adults. Neonatal cases are exceptional. We report the observations of two newborn female twins, who were not breastfed, presenting a necrotizing lung disease due to the same strain of SA-PVL+ despite nasal decolonization measures taken. These two cases are informative and bring to light (1) the possibility of severe SA-PVL+ lung infections in young infants and (2) their strictly intrafamilial mode of transmission for which eradication measures were ineffective.

Aerial dispersal of meticillin-resistant Staphylococcus aureus in hospital rooms by infected or colonised patients.

The aim of this study was to assess to what extent patients with meticillin-resistant Staphylococcus aureus (MRSA) at respiratory sites shed viable MRSA into the air of hospital rooms. We also evaluated whether the distance from the patient could influence the level of contamination. Air sampling was performed directly onto MRSA-selective agar in 24 hospital rooms containing patients with MRSA colonization or infection of the respiratory tract. Samplings were performed in duplicate at 0.5, 1 and 2-3 m from the patients' heads. Clinical and environmental isolates were compared using antimicrobial resistance patterns and pulsed-field gel electrophoresis. MRSA strains were isolated from 21 out of 24 rooms, in quantities varying from between 1 and 78 cfu/m3. In each of the 21 rooms, at least one of the environmental isolates was identical to a clinical isolate from the patient in that room. There was no significant difference in MRSA counts between the distance from the patient's head and the sampler. This study demonstrates that most patients with MRSA infection or colonisation of the respiratory tract shed viable MRSA into the air of their room. The results emphasise the need to study MRSA in air in more detail in order to improve infection control recommendations.

Community-acquired methicillin-resistant Staphylococcus aureus pneumonia.

Community-acquired methicillin-resistant Staphylococcus aureus is increasingly recognized as an important pathogen causing skin and soft tissue infections. We report a case of severe necrotizing pneumonia caused by community-acquired methicillin-resistant S. aureus in a peripartum woman. This case illustrates that community-acquired methicillin-resistant S. aureus must be considered as a potential pathogen in severe community-acquired pneumonia.

[Community MRSA]. / Community MRSA.

Additional to epidemic methicillin resistant Staphylococcus aureus (haMRSA) which had been disseminated in and between hospitals, MRSA emerged in the community independent upon the nosocomial setting (caMRSA). caMRSA possess the capacity to form Panton-Valentine-Leukocidin (PVL) as a special virulence factor. In general PVL-positive S. aureus isolates are associated with necrotizing skin and soft tissue infections as well as with necrotizing pneumonia. caMRSA are less "broad" resistant against different groups of antibiotics as haMRSA and require special attention when performing antimicrobial susceptibility testing. Prevention of further dissemination of caMRSA requires appropriate diagnosis, therapy and sanitation of the carrier state. Hygienic measures have not only to be taken in ambulant treatment but also in households of affected patients.

Fatal pneumonia caused by Panton-Valentine Leucocidine-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA) transmitted from a healthy donor in living-donor liver transplantation.

Severe infections are the most dangerous complications in liver transplantation and their prevention is one of the major goals. A 60-year-old Saudi-Arabian female with decompensated hepatitis C liver cirrhosis received a right-lobe liver graft from her healthy daughter. After 9 days, the patient developed a rapidly progressive necrotizing pneumonia that was fatal in spite of extracorporal lung assist. The pneumonia was due to a Panton-Valentine Leucocidine-positive (PVL) methicillin-resistant Staphylococcus aureus (MRSA), or "community-acquired" MRSA, that had not been detectable in the patient preoperatively. The same strain of PVL-MRSA could be demonstrated in the nares of the asymptomatic donor, but not of other relatives, patients, or medical staff. These findings strongly suggest transmission of PVL-MRSA from the donor to the recipient. This case demonstrates a previously unknown, and potentially fatal, risk in living-donor liver transplantation: transmission of a severe infection from a healthy donor to the recipient.

[Staphylococcal pneumonia in a premature neonate: unusual transmission of nosocomial infection]. / Staphylococcie pulmonaire chez un prématuré : infection nosocomiale de transmission inhabituelle.

UNLABELLED: Late onset of neonatal infection could have been transmitted in prenatal period, but it is usually secondary to a postnatal transmission. CASE REPORT: A premature neonate developed staphylococcal pneumonia at 18 days of life. Genomic typing of the strains of Staphylococcus aureus obtained from the patient and from his mother (found in the endocervix culture 48 h before delivery) was identical. These strains were different from those isolated in other neonates colonised by S. aureus in the unit during at that moment. CONCLUSION: The observed case of staphylococcal pneumonia may correspond to a nosocomial infection secondary to a pre- or postnatal transmission of the agent by the mother.

Breast milk transmission of a Panton-Valentine leukocidin-producing Staphylococcus aureus strain causing infantile pneumonia.

We report on a 38-day-old infant who developed pleuropneumonia due to a Staphylococcus aureus strain responsible for familial furunculosis, which was acquired by maternal breast-feeding. All isolates from the infant and parents were genetically related by randomly amplified polymorphic DNA analysis and produced Panton-Valentine leukocidin.

Clinical and epidemiologic investigations of nosocomial pulmonary infections caused by methicillin-resistant Staphylococcus aureus.

We evaluated the clinical features of 32 patients with pulmonary infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Most of the patients were elderly, postoperative, and had severe underlying diseases. Chest radiograph typically showed bilateral and multilobar involvement. Empyema was not common and no abscess was identified. Mortality rate was 38 percent. We also performed an epidemiologic study of MRSA infections by chromosomal DNA analysis using pulsed-field gel electrophoresis. Thirty-two strains were classified into 20 different types by chromosomal DNA pattern, and 5 epidemic strains were observed. These strains were considered to be transmitted among patients by hospital personnel.

Cefetamet pivoxil in community-acquired pneumonia: an overview.

A total of 305 patients with community-acquired pneumonia have participated in comparative or non-comparative studies involving cefetamet pivoxil. Of these, 211 (55 adults and 156 children) were involved in a series of open, prospective, comparator-controlled, multi-centre studies. Adults were randomized to receive either cefetamet pivoxil 1000 mg twice daily or amoxycillin 750 mg 3-times daily for 10 days. Children received either cefetamet pivoxil 10 mg/kg twice daily, cefetamet pivoxil 20 mg/kg twice daily or cefaclor 10 mg/kg 3-times daily for 7 to 8 days. The remaining 94 patients were treated openly with cefetamet pivoxil, with most patients receiving cefetamet pivoxil 500 mg twice daily for an average of 10 days; an elderly sub-group of these patients aged 70 to 103 years received therapy for an average of 11 days. The main causative organisms isolated were Streptococcus pneumoniae and Haemophilus influenzae. In adult patients, a successful clinical outcome was achieved in 100% of assessable patients receiving cefetamet pivoxil 1000 mg twice daily, and about 90% in those receiving 500 mg twice daily. The success rate in children was 98% for both dose levels of cefetamet pivoxil and 90% for those receiving cefaclor. In elderly patients, the percentage was 78% for the 500 mg twice daily patients. Thus, the standard dose of cefetamet pivoxil (500 mg twice daily in adults, 10 mg/kg twice daily in children) was well tolerated and proved to be at least as effective as the comparator drugs which were given 3-times a day.

Methicillin-resistant Staphylococcus aureus in a nursing home.

During a 13-month period, 25 residents of a nursing home were found to have positive cultures for methicillin-resistant Staphylococcus aureus (MRSA), including 17 with clinically significant infections. The outbreak came to attention in February 1985 when pneumonia was diagnosed in five residents during a 10-day period, and sputum cultures from all five were positive for MRSA. A survey revealed that nine (12%) of a sample of 74 residents and nine (7%) of 130 personnel had positive cultures for MRSA. Six of nine residents with MRSA detected in the culture survey had not been hospitalized for 6 or more months before the survey, suggesting acquisition of MRSA in the nursing home. Implementation of control measures was associated with a decreased occurrence but not complete elimination of new cases. MRSA in nursing homes is of concern because these institutions might serve as reservoirs for MRSA in the community. Further studies are required to define the magnitude of the problem, as well as optimal control measures.