Death by community-based methicillin-resistant Staphylococcus aureus: case report - Critical Care Science (CCS)

INTRODUCTION

Community methicillin-resistant Staphylococcus aureus (CA-MRSA) has by definition a minimum inhibitory concentration for oxacillin ≥ 4mcg/mL, giving it intrinsic resistance to all beta-lactams, including cephalosporins, which is associated with the presence of the mecA gene. It also has bacteriological and epidemiological characteristics distinct from hospital-acquired MRSA, including its resistance profile to other antimicrobials, its genotypic lineage, its genetic element that encodes methicillin resistance, and its toxin production profile.⁽⁾ There are few data on the prevalence of CA-MRSA in Brazil. Carvalho et al. identified a high rate of CA-MRSA colonization (7.4%) in healthy children attending day care centers in northeastern Brazil.⁽⁾ Gelatti et al. evaluated 104 samples from patients hospitalized with cutaneous infections in the community in southern Brazil, 58 of which were S. aureus isolates; of these, 8.6% were CA-MRSA.⁽⁾ CA-MRSA has been increasing worldwide in prevalence, causing concern due to its ability to cause fatal infections.⁽⁾ A study conducted in Cameroon showed a 20-30% increase in its prevalence in 2003, and the increase had reached 80% in 2019.⁽⁾ A meta-analysis of population prevalence studies in cities and regions of the United States revealed a dramatic increase in CA-MRSA infections in the last two decades, with CA-MRSA endemic strains at unprecedented levels in many regions of the United States in a heterogeneous pattern among regions, which seems to have occurred earlier in children than adults.⁽⁾

The CA-MRSA is transmitted through contact with a colonized individual or a contaminated surface, especially in healthy children and adolescents. The CA-MRSA clones may be more efficient than other strains in colonizing the human body and surviving on surfaces. Risk factors include situations of frequent physical contact, rupture of skin integrity, sharing of items, poor housing and hygiene conditions, crowding, sexual habit (sex between men), and exposure to various antibiotics. The risk of infection significantly increases with colonization.^(,,)

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