Infection à Staphylococcus aureus résistante à la méthicilline associée à la communauté

Community-associated MRSA infection refers to methicillin-resistant Staphylococcus aureus infection occurring in the community setting, distinguishable from health care-associated MRSA by genetic, epidemiologic, or microbiological profiles ^[2]. It is increasingly common worldwide and represents a distinct public-health concern relative to hospital-associated forms ^[1][2].

Community-associated MRSA typically manifests as purulent skin and soft tissue infection, though invasive disease can develop and progress to severe or complicated illness ^[2]. Infections are often recurrent and may transmit readily to close contacts ^[1]. Traditional understanding held that colonization precedes infection, but outbreak data indicate alternative acquisition routes are common ^[1].

Community-associated MRSA infection is rising in incidence worldwide and causes considerable morbidity and mortality ^[1][2]. Specific populations including indigenous Canadians and homeless persons are particularly affected ^[2]. It remains a common cause of skin and soft tissue infections and is prevalent where overcrowding and poor access to clean water occur ^[2].

Community-associated MRSA is highly transmissible to close contacts and often recurs ^[1]. Outbreak investigations indicate that skin-to-skin and skin-to-fomite contact are important and frequent routes of strain acquisition, alongside the traditional colonization-preceding-infection model ^[1].

Prevention strategies have included intranasal topical antibiotics for nasal decolonization based on the colonization-precedes-infection model ^[1]. However, because skin-skin and skin-fomite contact are common transmission routes, approaches modeled solely on health care-associated MRSA transmission may be flawed ^[1]. Effective prevention must reconsider community-specific pathogenesis rather than rely on hospital-oriented frameworks ^[1].

1. 1 Miller LG et al. Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis. 2008 Mar 1. PMID: 18220477. doi: 10.1086/526773. PubMed: https://pubmed.ncbi.nlm.nih.gov/18220477/
2. 2 Loewen K et al. Community-associated methicillin-resistant Staphylococcus aureus infection: Literature review and clinical update. Can Fam Physician. 2017 Jul. PMID: 28701438. PubMed: https://pubmed.ncbi.nlm.nih.gov/28701438/