Emergence of methicillin-resistant Staphylococcus aureus as a community pathogen.

Methicillin-Resistant Staphylococcus aureus (MRSA) infection is an established nosocomial pathogen, with hospital-based outbreaks occurring worldwide. An increase in MRSA infections without risk factors has been recently documented in several reports. A prospective study was conducted over a 36-month period to determine the prevalence and risk factors for community-acquired MRSA infection at King Fahad Hospital of the University Al-Khobar, Saudi Arabia. Patients hospitalized within the previous 12 months or transfers from hospitals or nursing homes were excluded. The number of patients with community-acquired MRSA disease increased from a single patient in 1998 to fifteen patients in the year 2000 and the percentage of community-acquired MRSA/total number of MRSA increased from 5% to 33%. Fifteen (75%) of 20 patients with community-acquired MRSA infection had no discernible characteristics of MRSA infections. Skin and soft tissue infections were the predominant presentation. Most MRSA isolates (95%) were susceptible to multiple antibiotics. Our data suggest that MRSA is an emerging community pathogen. Hospital infection control strategies will have to be redefined and community approaches developed to reduce transmission.

The epidemiology of methicillin-resistant Staphylococcus aureus at a Saudi university hospital.

To determine changes in the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA), a prospective study was conducted for a 30-month period in a university hospital in the eastern province of Saudi Arabia. Of 1,096 Staphylococcus aureus isolates identified, 92 (8.4%) were MRSA. Seventy-two (78%) of the 92 isolates were from nosocomial cases and 20 (22%) isolates were from community cases. Thirteen (14%) of 20 patients with community-acquired MRSA had no discernible risk factors. The community-acquired MRSA from patients without identified risk were susceptible to a greater number of antimicrobials compared with isolates obtained from patients with community-acquired MRSA with identified risk or with nosocomially acquired MRSA. No strain resistant to vancomycin was recorded in this study. The impact of these organisms could be substantial if they become more frequent or widespread.

Acute abdominal pain in women of child-bearing age remains a diagnostic dilemma.

Abdominal pain is perhaps the most challenging of all the presenting complaints in the emergency department. It is estimated that it accounts for 5%-10% of all visits. Causes of abdominal pain range from the inconsequential to the life threatening. In addition, it nearly always poses a greater degree of diagnostic uncertainty in women of child-bearing age as compared to males. Such difficulties become more pronounced in pregnant women where the unwritten policy seems to be: If she is pregnant blame the pregnancy. This policy is justified by the favorable clinical outcomes. However, in a small but significant number of patients, this policy has the potential of creating delays and increasing the risk of unwarranted complications. Delays in management may lead to emotional trauma, loss to the society, and the potential for serious liability.This review was undertaken at King Fahd hospital of the University, Eastern Province of Saudi Arabia, with a literature search covering a period of over twenty years. It mainly highlights the diagnostic difficulties in young women presenting with acute onset abdominal pain, and possible solutions.It also suggests a policy which includes a careful clinical approach with liberal consults between the surgeon and the gynecologist reinforced by a judicious use of the available diagnostic aids leading to potentially favorable outcomes.