Managing skin and soft-tissue infection and nosocomial pneumonia caused by MRSA: a 2014 follow-up survey
Introduction
In 2009, we surveyed European physicians about their opinions and practice on the epidemiology and management of meticillin-resistant Staphylococcus aureus (MRSA) infections [1]. The epidemiology of MRSA varied significantly across Europe at that time and there were differing views on treatment and the role of the limited novel antibiotics, namely linezolid, tigecycline and daptomycin.
Five years ago, the incidence of healthcare-associated MRSA (HA-MRSA) was very high; however, there was evidence to suggest that the epidemiology of HA-MRSA was changing [2]. At that time, community-acquired MRSA (CA-MRSA) was very rare in Europe, unlike in North America where it was the most common cause of community-acquired skin and soft-tissue infection [3, 4, 5]. Following the dramatic rise in community-acquired cases across North America, there was concern that Europe might experience the same phenomenon. If this did occur, the survey respondents felt that there would be a considerable shift in community antibiotic use in Europe.
Today, the epidemiology of HA-MRSA in Europe is, if anything, even more polarised, with significant reductions in HA-MRSA in some European countries [6] and persisting high levels of HA-MRSA in others [7]. The incidence is also directly proportional to the volume of antibiotic usage across the continent [8], providing potent support for the development of effective pan-European antimicrobial stewardship programmes.
Although CA-MRSA played only a minor role in Europe 5 years ago, it has become more common, as originally feared [9]. Many strains may persist and cause recurrent infection, as well as being highly pathogenic by virtue of eliciting the Panton–Valentine leukocidin (PVL) cytotoxin. These strains may exhibit some interesting and challenging epidemiology, with some strains emerging in livestock [10] and others dispersing widely around the world.
Treatment of MRSA has largely focused on the use of glycopeptides, with many older antibiotics, such as doxycycline, trimethoprim/sulfamethoxazole (SXT), clindamycin, fusidic acid and rifampicin being used for outpatients and those with minor infections. However, there is now a wealth of knowledge regarding the use of linezolid [7] and daptomycin in MRSA [11], whilst our knowledge of tigecycline is gradually increasing [12, 13, 14, 15], and many other novel antibiotics will soon become available or are currently under development, i.e. ceftaroline, tedizolid, dalbavancin and oritavancin.
The objectives of this survey were: (i) to explore current opinion and practice on MRSA complicated skin and soft-tissue infections (cSSTIs) and MRSA nosocomial pneumonia (NP) in Europe and, where possible, to compare the results with the findings of the survey 5 years ago; (ii) to review current physician opinion on practical and controversial questions around antibiotic choice, dose, duration and route of administration; (iii) to try and understand any developments and evolution in the management of MRSA infections in Europe over the past 5 years; and (iv) to support antibiotic stewardship.
Section snippets
Development of the survey
Members of an expert panel of infectious diseases specialists convened in London (UK) in January 2014 with the aim of identifying key current issues in the management of MRSA for a survey to capture the full diversity of opinion and practice within the European community. Following this meeting, a survey comprising 36 questions covering a wide range of topics on MRSA cSSTI and NP management was developed.
Survey administration
Following the development of these questions, a web-based questionnaire (Survey Monkey; //www.surveymonkey.com
Demographic characteristics of survey participants
The survey was publicised by the ISC to European societies of microbiology and infectious diseases, but it was not possible to establish how many potential respondents were contacted. In total, there were 430 survey respondents across all countries, of whom 350 (81.4%) were based in Europe. The results of this survey are based on the European respondents only.
The majority of European respondents were from Italy (32.4%), the UK (23.3%), Turkey (18.5%) and France (12.4%), with a smaller number of
Discussion
This survey follows on from the original survey conducted in 2009 [1] and takes a European perspective on the role and management of MRSA in cSSTI and NP infections. Both surveys were carried out using SurveyMonkey, a web-based questionnaire; however, unlike the previous survey, and due to reasons of data protection, publicity was kindly provided by the ISC. The ISC informed all of their European-associated societies, who in turn contacted their members. Whilst we appreciate that this approach
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2020, International Journal of Infectious DiseasesOnce-daily oral omadacycline versus twice-daily oral linezolid for acute bacterial skin and skin structure infections (OASIS-2): a phase 3, double-blind, multicentre, randomised, controlled, non-inferiority trial
2019, The Lancet Infectious DiseasesCitation Excerpt :Considering the substantial burdens for patients and health-care systems associated with the management of serious ABSSSI, administration of oral-only omadacycline could reduce the proportion of patients who are admitted to hospital solely for infusion therapy to treat ABSSSI, as well as reducing the related treatment costs. Staphylococcus aureus and streptococci are the most frequently identified causes of ABSSSI, with S aureus being most common in purulent infections with abscess.8,9 The prevalence of meticillin-resistant S aureus (MRSA) infection is high, accounting for nearly half of all ABSSSI isolates in the USA and 10–50% of isolates in Europe.1,10–12
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2016, International Journal of Antimicrobial AgentsCitation Excerpt :The majority (79%) would switch to oral therapy once the patient was stable, whilst 21% would have the patient complete the treatment with the same i.v. antibiotic (7% in hospital and 14% in OPAT). Interestingly, 70% of respondents believed that ≥10 days was the optimum duration of therapy for patients with MRSA-cSSTI [50]. Country-specific variations in MRSA-cSSTI treatment patterns across 12 European countries were also evaluated in a recent retrospective medical chart review [18].
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2016, International Journal of Antimicrobial AgentsCitation Excerpt :Recent data on combination therapy of a glycopeptide or daptomycin with a cell wall-active agent for treating S. aureus bacteraemia suggest improvement could be possible in how we use these drugs for serious SSTI, but it is early days yet and further studies are needed. Finally, in a recent survey of when combination therapy is actually used in 45% of responses concerning proven cSSTIs due to MRSA, the most common combinations were vancomycin/teicoplanin plus rifampicin in 20.7%, vancomycin/teicoplanin plus aminoglycoside in 8.2%, SXT plus rifampicin in 4.3%, linezolid plus rifampicin in 3.0%, and daptomycin plus rifampicin in 2.6% [63]. Of note, a negative drug interaction between linezolid and rifampicin that resulted in decreased serum linezolid levels was identified in an in vivo study [64].
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2016, Clinical Microbiology and Infection