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0:05
I've listed here my
financial disclosures,
which include my consulting
arrangements with a number
of pharmaceutical companies
and research grants.
These are disclosures
that could be
potentially relevant to
the presentation today.
0:19
Let's talk about
community-acquired MRSA,
a pathogen that can occur in
community-acquired pneumonia,
but one that we need to have
a high level of suspicion about,
not necessarily treating
empirically in everybody,
but certainly thinking about
in those individuals who
have serious illness with
necrotizing pneumonia.
Generally, community-acquired
MRSA is not like nosocomial MRSA
and can occur in previously
healthy individuals.
The clinical features that suggest
that a patient is at risk for
community-acquired
MRSA includes:
cavitary pneumonia,
rapidly increasing
pleural effusion,
coughing up blood and
recent influenza in an individual
who was previously healthy.
Probably even more so than those who've
been vaccinated for pneumococcus,
where pneumococcus
would be less likely.
These are all things to
think about as risk factors
for community-acquired MRSA.
1:14
Community-acquired
MRSA, as I pointed out,
is not the same as
nosocomial MRSA.
Community-acquired MRSA
is a clonal illness.
It's commonly associated
with the pathogens
associated with
exotoxin production,
particularly the USA300
strain that produces
the Panton-Valentine
leukocidin, the PVL toxin.
It's that toxin
production that is so bad
for patients with
community-acquired MRSA.
It's the toxin
that is associated
with the necrotizing infection.
These individuals generally
have a higher degree of
antibiotic susceptibility
than those with nosocomial MRSA.
Nosocomial MRSA is not generally
associated with
toxin production,
and is generally not
associated with susceptibility
to clindamycin and
trimethoprim sulfa,
which is the case in
community-acquired MRSA.