rising methicillin-resistant staphylococcus aureus infections jurnal reading tht

8/10/2019 Rising Methicillin-Resistant Staphylococcus Aureus Infections Jurnal Reading Tht

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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



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



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.



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.



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.



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.



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.



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.



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.



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.



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



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

These infections are associated withprolonged hospital stays



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



LinezolidMember of oxazolidinone class of drugs

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

protein synthesis inhibitor



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.



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

rising methicillin-resistant staphylococcus aureus infections jurnal reading tht

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