 Methicillin resistance in S.

aureus is defined as an Oxacillin (MIC) > 4

microgram/mL. Isolates resistant to oxacillin or methicillin are also
resistant to all beta - lactam agents including cephalosporins.
 The mecA gene responsible for methicillin resistance
 Staphylococcal cassette chromosome (SCCmec).
 There are five SCCmec types (I-V) that vary in genetic
makeup and size.
 Hospital Associated
MRSA
HA - MRSA
type I, II, or III SCCmec
Multiple antibiotic resistance
Prolonged hospitalization
Community Associated
MRSA
CA - MRSA
type IV SCCmec
does not carry the multiple antibiotic
resistance
Sensitive to Bactrim, Clindamycin &
50% fluoroquinolones.
Panton-Valentine leukocidin
•SCCmec type IV CA-MRSA
•skin
•soft tissue
•necrotizing pneumonia
•MRSA USA300
12-29%
 Prior skin infection
 Previous antibiotic use
 Illicit drug use
 Tattoo recipients
 Prison residence
 Military personnel
 A higher body mass index
 Cosmetic body shaving
 Physical contact with a person who has
a draining lesion or is a carrier of MRSA
 Sharing equipment that is not cleaned
or laundered between users
 Antibiotic use within three months before admission.
 Hospitalization during the past 12 months.
 Diagnosis of skin or soft-tissue infection at admission
 HIV infection
 Skin or soft tissue infections.
 Necrotizing pneumonia.
 Necrotizing fasciitis
 Rapidly fatal septicemia
 Endocarditis
 Osteomyelitis