Community-associated staphylococcus aureus (CA-MRSA) in special groups
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2021-04-08
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de Souza, Camila Sena Martins [UNESP]
Teixeira, Nathalia Bibiana [UNESP]
de Lourdes Ribeiro de Souza da Cunha, Maria [UNESP]
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Staphylococcus aureus is one of the pathogens most isolated in infections both in hospitals and in the community and it is a major problem for public health systems as it easily acquires resistance to the antimicrobials used. These bacteria are responsible for a wide variety of infections affecting the superficial tissues and also the deepest ones which are penetrated through the disruption of natural barriers. Due to this characteristic, they are associated to skin and soft tissue diseases, serious infections such as toxic shock syndrome, and sepsis, which are all conditions that can be fatal. In 1961, there were the first records of methicillin-resistant S. aureus (MRSA) and until the 1990s it was thought to be a nosocomial pathogen called HA-MRSA (Health-Care-associated Methicillin- Resistant Staphylococcus aureus) which caused serious infections in individuals with risk factors related to health care. However, its transmission in the community among individuals without risk factors has been reported in the last years, and in this context isolates with specific genetic characteristics, called CA-MRSA (Community-associated Methicillin-Resistant Staphylococcus aureus), have been identified. The transmission has occurred easily among detainees, athletes, military soldiers, men who have sex with men, injecting drug users, people with compromised mucous and skin, those with poor hygiene habits, and also children in nurseries due to their contact with contaminated nasal secretions. Some common factors of this spread are crowds, physical skin-to-skin contact with infectious lesions or skin damage, indiscriminate use of antibiotics, sharing personal items that may be contaminated and coming in contact with damaged skin, and also poor practice of hygiene rules, such as lack of hand washing that can lead to the transmission of the bacteria in places like prisons. More recently, long-term care facilities (LTCFs) have been recognized as reservoirs of this pathogen more and more often, probably due to the old patients' age, their lifestyle, need for invasive devices, the presence of chronic wounds, and their dependence on health workers and previous hospitalization. All of these result in many cases of MRSA colonization which remain unrecognized and lead to a spread among the elderly, family members, and health professionals because of their direct contact with them. In addition, the elderly are hospitalized more often and they can be a source of such microorganisms both in hospitals and in the community. People who have HIV/AIDS (PVHA) also have a higher risk of S. aureus colonization and therefore of infections such as bacteremia, endocarditis and skin infections. S. aureus has also been responsible for the colonization of insulin-dependent diabetics, which increases the predisposition of such individuals to the development of serious infections. Keeping S. aureus under control in hospitals and in the community is a major public health concern that is highlighted by the continuing evolution of MRSA. This chapter will address the CA-MRSA in special groups such as PVHA, detainees, the elderly and diabetic patients showing the genetic profile, virulence characteristics and resistance pattern of these isolates aiming at better understanding its epidemiological profile and its impact on the community.
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The Encyclopedia of Bacteriology Research Developments, v. 11, p. 2091-2097.