Felis ISSN 2398-2950

Meticillin-resistant Staphylococcus aureus

Synonym(s): MRSA; meticillin-resistant S.aureus, MR-S. aureus

Contributor(s): Susan Dawson, Melissa Kennedy, Anette Loeffler

Introduction

Classification

Taxonomy

  • Genus: Staphylococcus.
  • Family: Micrococcaceae.
  • Species: aureus.
  • Antimicrobial-resistance: carries additional genetic marker mecA for methicillin-resistance and broad β-lactam resistance.

Etymology

  • Gk: staphyle - bunch of grapes; coccus - grain or berry; Latin: aureus - golden.
  • Meticillin (INN; international non-proprietory name) or Methicillin (USAN; United States adopted names): semisynthetic penicillin introduced for clinical use in 1959 but no longer manufactured today. Marker for broad β-lactam antibiotic resistance.

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Clinical Effects

Epidemiology

Epidemiology

  • See under 'Distribution'.

Habitat

  • Skin and mucosae of healthy animals.
  • Adhere to skin squames and hair.
  • Environmental contamination through squames and hair shed by the host.
  • May inhabit the gastrointestinal tract.
  • Preferred niche: nostrils.
  • Humans (nostrils and throat) are the preferred host for MRSA isolates most commonly.

Lifecycle

  • Reproduction by binary fission.

Transmission

  • Direct and indirect transmission.
  • In human hospitals, most important route via hand contact.
  • Endogenous infection (opportunistic infection by commensal strains).
  • Transmission between pets and in-contact people in both directions but human-to-pet considered original direction as isolates typically human-healthcare associated strains ("reverse zoonosis").

Pathological effects

  • MRSA infections show the same pathology as those due to meticillin-susceptible S. aureus and other Staphlococcus spp.
  • Typicaly skin and ear infections, traumatic and post-surgical wound infections, often associated with implants, suture material and biofilm.
  • Other organs can be involved in infection (eg urinary tract, respiratory tract) as for other staphylococci.
  • No known lasting immunity after recovery.
  • Severe, life-threatening soft tissue infections reported in people with toxin-producing PVL-positive MRSA (currently rare in pets).

Other Host Effects

  • Same as for other Staphylococcus spp and as for meticillin-susceptible S. aureus.
  • MRSA can colonize skin and mucous membranes of healthy animals and predispose to subsequent (endogenous) MRSA infection.
  • Has host-preference but is not host-specific, ie can contaminate or colonize non-preferred host species and cause infection in immune-compromised individuals (opportunistic).

Control

Control via chemotherapies

  • All MRSA strains are resistant to all penicillins, most cephalosporins and carbapenems.
  • Topical antibacterial therapy should be used whenever appropriate (surface and superficial skin, wound and ear infections).
  • 2-4% chlorhexidine Chlorhexidine preparations and/or fusidic acid Fusidic acid containing creams have good efficacy if owner and pet are compliant.
  • Individual isolates can be susceptible to tetracyclines, lincomycin, potentiated sulfonamide.
  • Antibacterial choice must always be based on sensitivity testing.
  • Prognosis can be good depending on prognosis of underlying primary problem that led to infection.

Vaccination

  • None commercially available.

Other countermeasures

  • For known MRSA patients: barrier nursing:
  • Outpatients should be booked in for last appointment of the day.
  • Waiting and walking in the practice should be minimized.
  • Rigorous hand hygiene (frequent and thorough).
  • Cleaning and disinfection of practice environment after every patient.

Diagnosis

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Morris O, Loeffler A, Davis F, Guardabassi L, Weese J S (2017) Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 28, 304-e69 PubMed.
  • Harrison E M, Weinert L A, Holden M T, Welch J J, Wilson K, Morgan F J, Harris S R, Loeffler A, Boag A K, Peacock S J, Paterson G K, Waller A S, Parkhill J, Holmes M A (2014) A shared population of epidemic methicillin-resistant Staphylococcus aureus 15 circulates in humans and companion animals. MBio 5(3), e00985-13 PubMed.
  • Singh A, Walker M, Rousseau J, Monteith G J, Weese J S (2013) Methicillin-resistant staphylococcal contamination of clothing worn by personnel in a veterinary teaching hospital. Vet Surg 42, 643-648 PubMed.
  • McCarthy A J, Lindsay J A, Loeffler A (2012) Are all meticillin-resistant Staphylococcus aureus (MRSA) equal in all hosts? Epidemiological and genetic comparison between animal and human MRSA. Vet Dermatol 23(4), 267-75, e53-54 PubMed.
  • Walther B, Hermes J, Cuny C, Wieler L H, Vincze S, Abou Elnaga Y, Stamm I, Kopp P A, Kohn B, Witte W, Jansen A, Conraths FJ, Semmler T, Eckmanns T, Lübke-Becker A (2012). Sharing more than friendship--nasal colonization with coagulase-positive staphylococci (CPS) and co-habitation aspects of dogs and their owners. PLoS One 7, e35197 PubMed.
  • García-Álvarez L, Holden M T, Lindsay H, Webb C R, Brown D F, Curran M D, Walpole E, Brooks K, Pickard D J, Teale C, Parkhill J, Bentley S D, Edwards G F, Girvan E K, Kearns A M, Pichon B, Hill R L, Larsen A R, Skov R L, Peacock S J, Maskell D J, Holmes M A (2011) Meticillin-resistant Staphylococcus aureus with a novel mecA homologue in human and bovine populations in the UK and Denmark: a descriptive study. Lancet Infect Dis 11(8), 595-603 PubMed.
  • Loeffler A, Pfeiffer D U, Lloyd D H, Smith H, Soares-Magalhaes R, Lindsay J A (2010) Meticillin-resistant Staphylococcus aureus carriage in UK veterinary staff and owners of infected pets: new risk groups. J Hosp Infect 74(3), 282-288 PubMed.
  • Loeffler A, Lloyd D H (2010) Companion animals: a reservoir for methicillin-resistant Staphylococcus aureus in the community? Epidemiol Infect 138(5), 595-605 PubMed.
  • Loeffler A, Pfeiffer D U, Lindsay J A, Soares-Magalhaes R, Lloyd D H (2010) Lack of transmission of methicillin-resistant Staphylococcus aureus (MRSA) between apparently healthy dogs in a rescue kennel. Vet Microbiol 141(1-2), 178-181 PubMed.
  • Soares Magalhães R J, Loeffler A, Lindsay J, Rich M, Roberts L, Smith H, Lloyd D H, Pfeiffer D U (2010) Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in dogs and cats: a case-control study. Vet Res 41(5), 55 PubMed.
  • Weese J S, Dick H, Wiley B M, McGeer A, Kreiswirth B N, Innis B & Low D E (2006) Suspected transmission of methicillin-resistant Stapylococcus aureus between domestic pets and humans in veterinary clinics and in the household. Vet Microbiol 115(1-3), 148-155 PubMed.
  • Rankin S, Roberts S, O'Shea K, Maloney D, Lorenzo M, Benson C E (2005) Panton valentine leukocidin (PVL) toxin positive MRSA strains isolated from companion animals. Vet Microbiol 108(1-2), 145-148 PubMed.
  • van Duijkeren E, Wolfhagen M J, Heck M E, Wannet W J (2005) Transmission of a Panton-Valentine leucocidin-positive, methicillin-resistant Staphylococcus aureus strain between humans and a dog. J Clin Microbiol 43(12), 6209-6211 PubMed.
  • Duquette R A & Nuttall T J (2004) Methicillin-resistant Staphylococcus aureus in dogs and cats: an emerging problem? JSAP 45(12),587-588 PubMed.
  • Owen M R, Moores A P & Coe R J (2004) Management of MRSA septic arthritis in a dog using a gentamicin-impregnated collagen sponge. JSAP 45(12), 609-612 PubMed.
  • van Duijkeren E, Wolfhagen M J H M, Box A T A, Heck M E O C, Wannet W J B, Fluit A C (2004) Human-to-dog transmission of Methicillin-resistant Staphylococcus aureus. Emerg Infect Dis 10(12), 2245-2244 PubMed.
  • Manian F A (2003) Asymptomatic nasal carrriage of mupirocin, methicillin-resistant Staphylococcus aureus (MRSA) in a pet dog associated with MRSA infection in household contacts. Clin Infect Dis 36, 26-28.
  • Seguin J C, Walker R D, Caron J P, Kloos W E, George C G, Hollis R J et al (1999) Methicillin-resistant Staphylococcus aureus outbreak in a veterinary teaching hospital: Potential human-to-animal-transmission. J Clin Microbiol 37, 1459-1463.
  • Tomlin J, Pead M J, Lloyd D H, Howell S, Hartmann R, Jackson H A et al (1999) Methicillin-resistant Staphylococcus aureus infections in 11 dogs. Vet Rec 144, 60-64.
  • Cefai C, Ashurst S & Owens C (1994) Human carriage of methicillin-resistant Staphylococcus aureus linked with pet dog. Lancet 344(8921), 539-540.

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