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Selected Staphylococcal Diseases
Staphylococcus aureus is a common colonizer of human skin and may be found in the anterior nose of up to 30% of asymptomatic persons. It is among the commonest causes of skin and soft tissue infections.
In Georgia, only certain staphylococcal infections are notifiable conditions. These include:
About
Vancomycin resistance in S. aureus is an emerging problem and a dangerous development. S. aureus infections, including skin and soft tissue infections are very common, as are invasive bloodstream infections among hospitalized persons. Treatment of invasive S. aureus infections has increasingly relied on vancomycin because of widespread S. aureus resistance to other antibiotics. Fortunately, VRSA remains rare so far; in 2008 fewer than 10 cases have been identified; all in the U.S. and none in Georgia. However, VISA is becoming increasingly common in Georgia and many other places.
VISA and VRSA are defined by the minimal inhibitory concentration (MIC) of vancomycin; that is, the amount of vancomycin that will stop them from growing. The isolate is VISA If the vancomycin MIC is 4-8 μg/ml, and the isolate is VRSA if the MIC is >16 μg/ml.
Testing for vancomycin resistance can be problematic, making it important that suspected VISA/VRSA isolates are confirmed by a reference laboratory. All such isolates should be submitted to the Georgia Public Health Laboratory.
Vaccination & Prevention
There is no vaccine to prevent S. aureus infections. Because S. aureus are typically carried in the nose and on the skin, general prevention measures include covering coughs and sneezes, good hand hygiene, and covering open wounds to prevent contamination. Personal items that contact skin (such as towels, razors, or bar soap) should not be shared. Antibiotic use promotes carriage of and infection with bacteria that are antibiotic-resistant. Unnecessary antibiotics should be avoided for this and other reasons, such as cost, side-effects, and allergies.
More about
Investigation and control of vancomycin-intermediate and -resistant S. aureus: A Guide for Health Departments and Infection Control Personnel 
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About
Antibiotic resistance in Staphylococcus aureus has been a growing problem since penicillin was first introduced in the 1940s. Staphylococcal penicillin resistance developed in the 1950s, followed by methicillin resistance in the 1970s, but methicillin resistance was largely found in hospitals and not in the community. Since the late 1990s, MRSA has become a widespread cause of disease in the community, associated with the emergence of a new and virulent strain known as USA-300. During the first few years of this century, CA-MRSA spread rapidly in Georgia and is now a widespread and common cause of infections.
Community-associated MRSA (CA-MRSA) can affect otherwise healthy individuals with no exposure to settings where antibiotic resistance is expected, like hospitals. CA-MRSA frequently causes skin or soft-tissue infections that contain pus. Most of these are uncomplicated and easily treated, but some CA-MRSA infections are severe, including sepsis, pneumonia, osteomyelitis (bone infection) or endocarditis (heart-valve infection). This strain is also becoming established in hospitals. To monitor the rapid emergence of this new S. aureus strain, severe disease caused by CA-MRSA is reportable statewide. Invasive disease is likely to be a small portion of CA-MRSA infections, and most CA-MRSA infections are not reportable. Public health is aware of this issue, but seeks to balance the burden of reporting with the severity of the infection that is reported.
In addition, in the 8-county Atlanta MSA, the Emerging Infections Program conducts active, laboratory-based surveillance for all cases of MRSA, and classifies them as either community-associated, healthcare-associated community-onset, or healthcare-associated hospital-onset. This surveillance system, although limited geographically, is considered to be a gold standard for quantitative information over time.
Vaccination & Prevention
There is no vaccine to prevent S. aureus infections. Because S. aureus are typically carried in the nose and on the skin, general prevention measures include covering coughs and sneezes, good hand hygiene, and covering open wounds to prevent contamination. Personal items that contact skin (such as towels, razors, or bar soap) should not be shared. Antibiotic use promotes carriage of and infection with bacteria that are antibiotic-resistant. Unnecessary antibiotics should be avoided for this and other reasons, such as cost, side-effects, and allergies.
Following multiple outbreak investigations, CDC has characterized risk factors ("the 5 C's") associated with CA-MRSA disease, which include Crowding, Close contact, Compromised skin, Contaminated surfaces and shared personal items, lack of Cleanliness, and in some outbreaks, prior antimicrobial use.
More about MRSA
Frequently Asked Questions About MRSA
Living With MRSA - A Guide for Patients and Their Families
Stop the Spread of MRSA (Poster)
Community-Onset MRSA (CDC)
About MRSA Skin Infections (CDC)
Methicillin-Resistant Staphylococcus aureus (Georgia Department of Public Health)
Georgia Epidemiology Report – Community Associated Methicillin-Resistant Staphylococcus aureus in Georgia, 2004-2007
For Healthcare Providers
Think MRSA! (Poster)
Don't Presume Susceptibility (Poster)
Staph skin infection patient fact sheet and instructions
MRSA Brochure
2006 Georgia Guidelines for Management of Suspected Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Skin and Soft Tissue Infections (SSTIs)
Information for Healthcare Professionals (CDC)
Materials for Healthcare Professionals (CDC)
Treatment Algorithm for Skin and Soft Tissue Infections (CDC)
For Schools
Questions and Answers about Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools (CDC)
MRSA Toolkit for Middle & High Schools
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About
In May 1980, toxic-shock syndrome (TSS) became a newly recognized illness characterized by high fever, sunburn-like rash, desquamation, hypotension, and abnormalities in multiple organ systems. This illness is caused by staphylococcal toxin production at the mucosal surface, and does not require invasive staphylococcal infection.
TSS was recognized because numerous cases were reported to CDC; nearly all occurred in women during menstruation; and were strongly linked to the use of high-absorbency "Rely" Tampons. These were withdrawn from the market in September 1980; manufacturers reduced the absorbency of their products; and the FDA instituted standardized absorbency labeling of tampons.
In addition to menstrual toxic shock, post-surgical toxic shock cases are reported. Rates of non-menstrual toxic shock have not changed over time, but menstrual toxic shock has declined substantially since first recognized.
Vaccination & Prevention
There is no vaccine to prevent S. aureus infections. To avoid menstrual TSS, women should use the lowest absorbency product that works, and maintain good overall hygiene.
More about
Toxic Shock Syndrome (CDC)
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