RESUMO
BACKGROUND: We investigated whether spa typing is useful for indicating the setting of methicillin-resistant Staphylococcus aureus (MRSA) acquisition (community or health care acquired), the clinical relevance (colonization or infection), the type of infection (invasive or noninvasive), and the clinical outcome. METHODS: Between August 2006 and December 2009, 381 routinely diagnosed culture-confirmed MRSA-positive patients were included into a cross-sectional study at an 800-bed hospital. RESULTS: Out of 159 patients with colonization, 27 (17%) acquired MRSA in the community (CA-MRSA) and 123 (77.4%) in health care settings (HA-MRSA), and, of the 222 patients with infections, 119 (53.6%) had HA-MRSA and 103 (46.4%) had CA-MRSA. The 10 most frequent spa types accounted for 68.2% of the 346 typed MRSA isolates: t190 (28.3%), t032 (16.5%), t041 (9.4%), t008 (8.4%), t001 (3.4%), t002 (2.9%), t044 (3.1%), t223 (2.1%), t015 (2.1%), t127 (1.3%). CONCLUSION: Spa typing of routinely identified MRSA isolates is unsuitable to predict the likeliness of an infection, of an invasive infection, and the clinical outcome. Molecular criteria such as spa type or Panton-Valentine leukocidin positivity used for classifying MRSA as either belonging to a community or hospital clone are of limited value to indicate the setting, where the MRSA strain was actually acquired according to epidemiologic criteria.
Assuntos
Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas/diagnóstico , Infecção Hospitalar/diagnóstico , Exotoxinas/análise , Leucocidinas/análise , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Tipagem Molecular , Infecções Estafilocócicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Áustria , Biomarcadores/análise , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesAssuntos
Entamoeba histolytica , Entamebíase/diagnóstico , Entamebíase/parasitologia , Fissura Anal/diagnóstico , Fissura Anal/parasitologia , Adulto , Canal Anal/patologia , Biópsia , Condiloma Acuminado/cirurgia , Diagnóstico Diferencial , Disenteria Amebiana/diagnóstico , Disenteria Amebiana/parasitologia , Disenteria Amebiana/patologia , Entamoeba histolytica/ultraestrutura , Entamebíase/patologia , Fezes/parasitologia , Fissura Anal/patologia , Humanos , Masculino , Reação em Cadeia da Polimerase , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/parasitologia , Complicações Pós-Operatórias/patologiaRESUMO
In a 48-year-old immunocompetent man with recurrent fever since 21 months, endocarditis of the native aortic valve due to Staphylococcus warneri was diagnosed. Twenty-six months before, a prosthetic lumbar disc had been implanted in L 4/5. The lack of typical other infectious sources favours the hypothesis of a disc-prosthesis-induced bacteraemia.
