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experts comment on new research regarding Community-Acquired MRSA and pneumonia, as published in The Lancet Infectious Diseases

The paper identifies the emerging threat of cases of necrotising pneumonia caused by community-acquired MRSA (CA-MRSA) infections.

Dr Alison Holmes, Reader in Infection Prevention and Control, Imperial College London, said:

“We need to be aware that in this country we should be concerned about Community-acquired Methicillin-sensitive S.aureus (MSSA) that has this same toxin (PVL) and can cause severe aggressive disease, including lung involvement, particularly in young people.

“There is a need for the development of comprehensive surveillance and a raising of clinical awareness for the early diagnosis and appropriate treatment.”

Professor Ron Cutler, Deputy Director of Biomedical Science, Queen Mary University of London, said:

“In the past respiratory tract infections with MRSA tended to be in the elderly in a hospital ward. These infections could have been post viral and with a weakened immune system and a poor response to antibiotics were and still are difficult to treat successfully.

“The CA strains are able because of their increased toxic potential to infect a younger population. They have normally a degree of antibiotic resistance but not as great as some of the hospital strains that can now be resistant to vancomycin and other “last ditch” antibiotics. There have also been issues in the US of sports people being infected with CA-MRSA skin infections.

“The trouble with MRSA, is it can live in your nose and or throat causing no problems but if the defences of your respiratory tract are weakened by a virus infection then they can move from the nose/throat to the lungs where they can be a lethal problem.”

Professor Richard James, Director, Centre for Healthcare Associated Infections, University of Nottingham, said:

“The threat from CA-MRSA in the USA is very serious concern, especially if there is a flu epidemic as this could trigger a large number of cases of necrotizing pneumonia, which has a mortality rate of >50% in 72 hours.

“There have been few cases of USA300 infections in Europe, even though this strain is now the most commonly reported MRSA strain causing infections in the USA. The reasons for this difference are not entirely clear.

“Strains like USA300 that produce the PVL toxin are being reported more frequently in the UK by the Health Protection Agency. The concern is that this may be the start of an exponential increase as we saw with hospital MRSA infections in the 1990s. It took the UK 13 years to get to grips with HA-MRSA infections in our hospitals, we are not equipped to deal with large numbers of CA-MRSA infections in the community.

“Methicillin-sensitive S.aureus (MSSA) strains that produce the PVL toxin can cause very serious disease but will not be identified and reported by the MRSA screening of patients admitted to hospital for elective surgery in England that started in March 2009.

“CA-MRSA infections spread rapidly between close family contacts so it is very important that good advice is given to individuals who are carrying CA-MRSA to help prevent its further spread in the community.”

Professor Mark C. Enright, Professor of Molecular Epidemiology, Imperial College London, said:

“Bacterial pneumonia following influenza can be very serious and in some cases fatal. Community-acquired (CA-) MRSA pneumonia is particularly dangerous due to the rapid, aggressive nature of the infection and the difficulty in providing effective chemotherapy. The emergence of pandemic influenza and increased prevalence of CA-MRSA in many countries may cause increased morbidity and mortality in infected individuals.”

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