rising methicillin-resistant staphylococcus aureus infections jurnal reading tht

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Presented by:  Addini Rosefani, S.Ked  Ayu Marsyah Wulandari, S.Ked Kevin Audrino Budiman, S.Ked M.Ogi Yuhamzi, S.Ked Ridwan, S.Ked Syadzwina Syaufika, S.Ked

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    Presented by: Addini Rosefani, S.Ked

    Ayu Marsyah Wulandari, S.KedKevin Audrino Budiman, S.Ked

    M.Ogi Yuhamzi, S.KedRidwan, S.Ked

    Syadzwina Syaufika, S.Ked

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    1. Introduction Methicillin-resistant Staphylococcus aureus(MRSA) has become a serious problem invarious diseases such as skin and softtissue infections, including sinonasal and earinfections.

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    Widespread use of broadspectrumantibiotics and previous nasal surgeriescontribute much to the emergence ofMRSAOral linezolid combined with localmupirocin therapy is found to be safe

    and well tolerated, reduces hospital stay,and is cost effective compared to otherantibiotics.

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    2. Case Number 1 A 19-year-old adolescent male with a historyof chronic tonsillitis, deviated nasal septumwith purulent left maxillary sinusitis,underwent tonsillectomy in January 2014and had a hospital stay in general ward for 5days inclusive of preoperative and

    postoperative period, which was uneventful.

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    Cont..

    Six weeks later, he underwentseptoplasty with functional endoscopicsinus surgery. Frank pus was drainedout from the left maxillary sinus andnormal saline wash was given to clearthe pus completely. On 2nd

    postoperative day patient developedunusual nasal bleeding on merocel packremoval.

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    He was conservatively managed withregular nasoendoscopic suctioning buthe continued to have epistaxis. Nasalendoscopy revealed severeinflammation with edematous nasalmucosa and generalized oozing from

    the lateral wall of nose and septal flaps.

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    Cont

    He was empirically started withintravenous Augmentin 1.2 gm twicedaily. Nasal swab cultures were positivefor MRSA, which was sensitive tovancomycin, rifampicin, linezolid,daptomycin, and tetracycline but

    resistant to penicillin, ciprofloxacin,clindamycin, levofloxacin,erythromycin,and oxacillin.

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    Cont After 2 weeks of surgery he complained ofsevere pain, swelling of left auricle. Onexamination, the left auricle was tender, tenseand edematous. Operated mastoid cavity

    hadremnant gelfoamin situ.He was readmitted for postoperativeperichondritis left ear and empirically started onintravenous Augmentin 1.2 gm twice daily but it

    turned into perichondrial abscess within 48hours, showing no improvement. Abscess wasdrained out. Swab cultures were positiveforMRSA.

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    Cont

    Oral linezolid 600mg twice dailycombined with local mupirocin ointmentdressing was done for 10 days. Therewas significant improvement with nofurther pus collection. Perichondritisresolved completely and the patient was

    discharged.

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    4. Discussion

    The probable risk factor was previous nasalsurgeries in adults and previous increasedfrequency of antibiotic usage in children.Both patients with MRSA infections describedabove were operated for chronic maxillarysinusitis and unsafe chronic suppurative otitismedia.

    Both had the history of chronic antibioticusage for their infections before gettingoperated.

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    The frequency of MRSA was found to besignificantly higher in adults with otitismedia than in children

    Like other strains of S. aureus, the bodysite most commonly colonizedwithMRSA is the anterior nares

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    About 40% to 60% of hospitalizedpatients colonized with MRSA developan overt infection.

    These infections are associated withprolonged hospital stays

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    Intravenous vancomycin and daptomycin are

    considered to be the first line antibioticchoices for MRSA bacteraemiaThe emergence of vancomycin resistantMRSA proves the necessity for newgeneration antibiotics like linezolid in thetreatment of MRSA infections

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    LinezolidMember of oxazolidinone class of drugs

    A synthetic antibiotic active againstmostgrampositive bacteria that are resistant toseveral other antibiotics.Mechanism of action:

    protein synthesis inhibitor

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    Advantages of linezolid

    High bioavailability (close to 100%)Low plasma protein binding (approximately31%).

    Adequate penetration into the tissuesOral linezolid therapy is safe and welltolerated

    Reduces hospital stayCost effective compared to vancomycinIt can be used in patients of all ages, people

    with liver disease or poor kidney function.

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    5. Conclusion Oral linezolid with local mupirocin is found tobe a good alternative to its intravenouscomparators forMRSA complicatedsinonasal and ear infections.

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