Community-associated Methicillin-resistant Staphylococcus aureus Skin Infections in the Tropics - 11/08/11

Doi : 10.1016/j.det.2010.09.005

Steven Y.C. Tong, MBBS, FRACP, PhD ^a,^b,^⁎ , Andrew C. Steer, MBBS, FRACP, PhD ^c, Adam W. Jenney, MBBS, FRACP, PhD ^c,^d, Jonathan R. Carapetis, MBBS, FRACP, PhD, MPH ^b,^e
^a Tropical and Emerging Infectious Diseases, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, Northern Territory 0811, Australia
^b Infectious Diseases Department, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, Northern Territory 0811, Australia
^c Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
^d Infectious Diseases Unit, The Alfred Hospital, 75 Commercial Road, Melbourne, Victoria 3004, Australia
^e Child Health, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, Northern Territory 0811, Australia

Corresponding author. Child Health, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, Northern Territory 0811, Australia.

Résumé

Skin and soft tissue infections (SSTI) caused by Staphylococcus aureus are very common, particularly in children, in tropical regions. The proportion of S aureus SSTI caused by community-associated methicillin-resistant S aureus (CA-MRSA) varies according to region, but is up to 25% in some areas. There are diverse CA-MRSA clones, including several that harbor Panton-Valentine leukocidin. Key predisposing factors for staphylococcal infections are scabies infestation, overcrowding, poor hygiene, and inadequate water supplies. In the setting of a community outbreak of staphylococcal SSTI, interventions intended to improve personal and community hygiene are likely to be the most practical, effective, and achievable. Options for oral treatment of clinical infections caused by CA-MRSA include clindamycin and trimethoprim-sulfamethoxazole. Although rapid diagnostics are now available, and 2 vaccines have reached clinical trials, neither of these is likely to be of use in tropical, developing regions in the near future.

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Keywords : Community-associated, Methicillin-resistant Staphylococcus aureus, MRSA, Staphylococcus aureus, Skin and soft tissue infection, Tropical