Acute Bivalvular Left-Sided Methicillin-Resistant Staphylococcus Aureus Endocarditis with Cardiac, Cerebral, Renal and Septic Complications

Infective endocarditis (IE) is now rare in developed countries, but its prevalence is higher in elderly patients with prosthetic valves, diabetes, renal impairment, or heart failure. An increase in health-care associated IE (HCAIE) has been observed due to invasive maneuvers (30% of cases). Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus are the most common agents in HCAIE, causing high mortality and morbidity. We review complications of IE and its therapy, based on a patient with acute bivalvular left-sided MRSA IE and a prosthetic aortic valve, aggravated by congestive heart failure, stroke, acute immune complex glomerulonephritis, Candida parapsilosis fungémia and death probably due to Serratia marcescens sepsis. The HCAIE was assumed to be related to three temporally associated in-hospital interventions considered as possible initial etiological mechanisms: overcrowding in the hospital environment,iv quinolone therapy and red blood cell transfusion. Later in the clinical course,C. parapsilosis and S. marcescens septicemia were considered to be possible secondary etiological mechanisms of HCAIE.

Tamponamento Cardíaco Secundário a Pericardite por Staphylococcus Aureus Meticilino Resistente: Importância da Imunossupressão

As pericardites bacterianas, apesar da sua baixa incidência e das terapêuticas actuais, apresentam um prognóstico desfavorável, sobretudo quando causadas por Staphylococcus aureus meticilino resistente (MRSA). O Tamponamento cardíaco é uma complicação potencialmente letal nos doentes com pericardites por este agente. Numa Unidade de Cuidados Intensivos, para além da imunossupressão, constituem factores predisponentes para este tipo de infecção, a elevada taxa de colonização nasal e cutânea, assim como a utilização de técnicas invasivas (1) entre as quais a simples colocação de catéteres intravenosos. Relatam-se dois casos clínicos de tamponamento cardíaco em doentes jovens, no contexto de imunossupressão de diferentes etiologias (infecção HIV e pós transplante hepático). Os internamentos foram complicados de quadros sépticos importantes com isolamento de MRSA nos líquidos biológicos e desenvolvimento de pericardite bacteriana e subsequente tamponamento cardíaco. Os autores salientam a importância dos quadros clínicos infecciosos em doentes imunodeprimidos, que constituem uma população cada vez mais numerosa, e a importância da monitorização ecocardiográfica na evolução prognóstica das pericardites bacterianas no contexto de sépsis.

Community-Associated Methicillin-Resistant Staphylococcus Aureus Lacking PVL, as a Cause of Severe Invasive Infection Treated with Linezolid

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging public health problem worldwide. Severe invasive infections have been described, mostly associated with the presence of Panton-Valentine leukocidin (PVL). In Portugal limited information exists regarding CA-MRSA infections. In this study we describe the case of a previously healthy 12-year-old female, sport athlete, who presented to the hospital with acetabulofemoral septic arthritis, myositis, fasciitis, acetabulum osteomyelitis, and pneumonia.The MRSA isolated from blood and synovial fluid was PVL negative and staphylococcal enterotoxin type P (SEP) and type L (SEL) positive, with a vancomycin MIC of 1.0mg/L and resistant to clindamycin and ciprofloxacin. The patient was submitted to multiple surgical drainages and started on vancomycin, rifampicin, and gentamycin. Due to persistence of fever and no microbiological clearance, linezolid was started with improvement. This is one of the few reported cases of severe invasive infection caused by CA-MRSA in Portugal,which was successfully treated with linezolid. In spite of the severity of infection, the MRSA isolate did not produce PVL.

Endemic Methicillin-Resistant Staphylococcus Aureus: Nurses' Risk Perceptions and Attitudes

Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care-associated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.