ABSTRACT
In this case-control study, cases [community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), n=79] and controls [community-associated methicillin-susceptible S. aureus (CA-MSSA), n=36] were defined as a laboratory-confirmed infection in a patient with no previous hospital-associated factors. Skin and soft tissue were the predominant sites of infection, both for cases (67.1%) and controls (55.6%). Most of the cases (79.7%) and controls (77.8%) were aged <30 years. Investigations did not reveal any significant statistical differences in acquiring a CA-MRSA or CA-MSSA infection. The most common shared risk factors included overcrowding, previous antibiotic usage, existing skin conditions, household exposure to someone with a skin condition, scratches/insect bites, and exposure to healthcare workers. Similar risk factors, identified for both CA-MRSA and CA-MSSA infections, suggest standard hygienic measures and proper treatment guidelines would be beneficial in controlling both CA-MRSA and CA-MSSA in remote communities.
Subject(s)
Community-Acquired Infections/epidemiology , Methicillin Resistance , Staphylococcal Infections/epidemiology , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Child , Child, Preschool , Community-Acquired Infections/microbiology , Crowding , Drug Utilization/statistics & numerical data , Family Health , Female , Humans , Infant , Insect Bites and Stings/complications , Male , Middle Aged , Risk Factors , Soft Tissue Infections/epidemiology , Soft Tissue Infections/microbiology , Staphylococcal Infections/microbiology , Staphylococcal Skin Infections/epidemiology , Staphylococcal Skin Infections/microbiology , Staphylococcus aureus/drug effects , Young AdultABSTRACT
We determined fluoroquinolone microbiological resistance breakpoints for Streptococcus pneumoniae by using genetic instead of pharmacokinetic-pharmacodynamic parameters. The proposed microbiological breakpoints define resistance as the MIC at which >50% of the isolates carry quinolone resistance-determining region mutations and/or, if data are available, when Monte Carlo simulations demonstrate a <90% chance of bacteriological eradication. The proposed microbiological resistant breakpoints are as follows (in micrograms per milliliter): gatifloxacin, >0.25; gemifloxacin, >0.03; levofloxacin, >1; and moxifloxacin, >0.12. Monte Carlo simulations of the once daily 400-mg doses of gatifloxacin and 750-mg doses levofloxacin demonstrated a high level of target attainment (free-drug area under the concentration-time curve from 0 to 24 h/MIC ratio of 30) by using these new genetically derived breakpoints.
