Volume 12, Number 1—January 2006
Letter
Community Case of Methicillin-resistant Staphylococcus aureus Infection
Lee Nelson*, Clive S. Cockram*, Grace Lui*, Rebecca Lam*, Edman Lam*, Raymond Lai*, and Margaret Ip*
Table
Comparison between methicillin-sensitive and methicillin-resistant strains of Staphylococcus aureus
| Strain and major resistance mechanism* |
||||
|---|---|---|---|---|
| MSSA/penicillinase production | BORSA/novel methicillinase ± penicillinase hyperproduction | CA-MRSA/PBP alteration | HA-MRSA/PBP alteration | |
| PBP2a detection (e.g., latex-agglutination method) | – | – | + | + |
| mecA gene detection (e.g., PCR method) | – | – | + (SCCmec IVa) | + |
| PVL gene detection (PCR method) | Infrequent (<5%) | Data limited | Frequent (>66%–100%) | Infrequent (<5%) |
| Coresistance to non–β-lactam antimicrobial drugs | ± | ± | + | +++ |
| Usual antimicrobial drugs to which MSSA is susceptible | PRP (e.g., cloxacillin), β-lactam/β-lactamase–inhibitor combinations (e.g., ampicillin /sulbactam); linezolid, vancomycin, erythromycin, clindamycin, trimethoprim-sulfamethoxazole, fluoroquinolones, rifampin, gentamicin, fusidic acid, tetracyclines | PRP (e.g., cloxacillin), β-lactam/β-lactamase–inhibitor combinations (e.g., ampicillin/sulbactam), other drugs to which MSSA is potentially susceptible | Vancomycin, linezolid, rifampin, gentamicin, trimethoprim-sulfamethoxazole, fusidic acid, tetracyclines, fluoroquinolone, clindamycin† | Vancomycin, linezolid; ± fusidic acid, rifampin, gentamicin, trimethoprim-sulfamethoxazole, fluoroquinolones‡ |
*MSSA, methicillin-susceptible Staphylococcus aureus; BORSA, borderline oxacillin-resistant S. aureus; MRSA, methicillin-resistant S. aureus; CA-MRSA, community-associated MRSA; HA-MRSA, hospital-associated MRSA; PBP, penicillin-binding protein; PCR, polymerase chain reaction; PVL, Panton-Valentine leukocidin; PRP, penicillinase-resistant penicillins; +, positive; –, negative. ±, occasionally present; +++, usually present.
†Concern over inducible clindamycin resistance; also, macrolide resistance is common.
‡Fluoroquinolone resistance increasing.
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