The origin of methicillin-resistant Staphylococcus aureus (MRSA) strains from otolaryngology outpatients has not been evaluated yet in Korea. We analyzed epidemiologic and genetic characteristics of MRSA isolates from the ear discharge of 64 outpatients with chronic otitis media in a Korean University Hospital during 2004. MRSA strains were grouped as either from the initial visit (n=33) or the follow-up visit (n=31) based on the timing of isolation. Healthcare-associated risk factors were frequently present among patients of the initial visit group, especially prior visit to primary clinic (79%) and antibiotic use (73%). SCCmec typing and multilocus sequence typing results showed that two genotypes, ST5-MRSA-II and ST239-MRSAIII, were prevalent in both the initial visit (73% vs. 24%) and the follow-up visit (55% vs. 42%). Pulsed-field gel electrophoresis identified eight types, including two major types shared by both groups. We conclude that majority of MRSA strains from ear discharge of chronic otitis media belonged to nosocomial clones that might be circulating in the community. This is the first report of the genetic analysis of MRSA strains from otolaryngology practices in Korea.
Adolescent ; Adult ; Aged ; Bacterial Typing Techniques ; Child ; Child, Preschool ; Chronic Disease ; Female ; Genotype ; Humans ; Infant ; Male ; Methicillin-Resistant Staphylococcus aureus/*genetics ; Middle Aged ; Otitis Media, Suppurative/complications/epidemiology/*microbiology ; Polymorphism, Restriction Fragment Length ; Risk Factors ; Staphylococcal Infections/complications/epidemiology/*microbiology

The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high, which are attributed to invasive procedures, bacteremia, and wound infection after burns. Clinical clues for IE in burns are usually masked by burn-related manifestations, so the diagnosis of IE may be delayed or missed. For burned patients with persistent bacteremia of unknown source, especially Staphylococcus aureus-induced bacteremia, the diagnosis of IE should be considered according to the Duke criteria, and early echocardiography performance is particularly important. Antibiotic therapy is the mainstay initial management, and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns. In order to lower the incidence and mortality of IE in burns, it is very important to take prophylactic procedures along with the whole course of burn management.
Bacteremia ; epidemiology ; Burn Units ; Burns ; complications ; mortality ; surgery ; Endocarditis, Bacterial ; complications ; diagnosis ; microbiology ; mortality ; Humans ; Incidence ; Severity of Illness Index ; Staphylococcal Infections ; complications ; diagnosis ; Staphylococcus aureus ; isolation & purification ; Surgery, Plastic ; Wound Infection ; etiology ; mortality

BACKGROUND/AIMS: Peristomal infection is the most common complication of percutaneous endoscopic gastrostomy (PEG) insertion. Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly implicated organism of peristomal infection. The aims of this study were to determine the contribution of nasal MRSA to wound infection in PEG and the predictors of wound infection. METHODS: A prospective study was conducted on patients undergoing PEG between September 2003 and July 2005. All patients received antibiotics prior to PEG insertion. Nasal swabs were taken from a consecutive series of patients prior to PEG insertion. Wound status of the peristomal site were prospectively evaluated at day 1, 3, and 7 following the insertion of PEG. RESULTS: Thirty-one patients underwent PEG insertion (mean age, 66+/-16 years). Ten patients (32.3%) had MRSA-positive nasal swabs. Peristomal infection did not have any relationship with nasal MRSA colonization (p>0.05). Peristomal infection occurred in 4 (12.9%) cases. The rate of peristomal infections was significantly higher in patients with diabetes mellitus (p<0.05). CONCLUSIONS: Nasal MRSA colonization is not associated with the risk of peristomal infections in patients receiving antibiotics prior to PEG insertion. Diabetes mellitus might be the risk factor for peristomal infection after PEG insertion.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology ; Diabetes Complications/epidemiology ; Female ; Gastroscopy ; *Gastrostomy ; Humans ; Male ; Methicillin/pharmacology ; *Methicillin Resistance ; Middle Aged ; Nose/microbiology ; Risk Factors ; Staphylococcal Infections/epidemiology/etiology/*microbiology ; Staphylococcus aureus/drug effects/*isolation & purification ; Surgical Wound Infection/epidemiology/etiology/*microbiology