Community-associated MRSA: Klinik, Therapie, Hygiene

Kernaussagen

Erreger. Als „CA-MRSA” werden Varianten von S. aureus bezeichnet, die eine erhöhte Antibiotikaresistenz (Beta-Laktame und andere) in Kombination mit besonderen Virulenzeigenschaften aufweisen. „CA” steht dabei für „community-associated” (wahlweise auch „adapted”, „acquired”), weil die Stämme im Unterschied zu bisherigen MRSA-Isolaten außerhalb medizinischer Einrichtungen bei Patienten ohne nosokomiale Risikofaktoren auftreten.

Krankheitsbilder. CA-MRSA verursachen typischerweise Haut-Weichteilinfektionen, die bei bis zu 30 % der Fälle multipel oder rezidivierend auftreten. Übertragungen auf Personen mit engem körperlichem Kontakt sind häufig. Selten kommt es zur Bildung von Abszessen in tiefen Kompartimenten oder schweren systemischen Erkrankungen mit hoher Letalität (Nekrotisierende Pneumonie, Nekrotisierende Fasziitis).

Diagnostik. Kultur, Resistenzbestimmung und Bestimmung des Virulenzmarkers „Panton-Valentine Leukozidin” sollten durchgeführt werden, wenn der klinische Verlauf bzw. anamnestische Angaben (Häufung von Erkrankungsfällen, Reiseanamnese) auf CA-MRSA hinweisen.

Therapie. Die primäre Therapie folgt allgemeinen Grundsätzen. Die Antibiotikaresistenz sollte beachtet werden. Zur Verhütung von rezidivierenden Infektionen bzw. schwerer Komplikationen sollte eine Sanierung des Trägerstatus durchgeführt werden.

Prävention. In medizinischen Einrichtungen, insbesondere im Bereich der Primärversorgung, sollten die bestehenden Hygienerichtlinien optimal umgesetzt werden. Infizierte oder kolonisierte Patienten sollten saniert werden. Für medizinisches Personal wird die Impfung gegen Influenza A empfohlen.

Epidemiologie. Weltweit wird in den letzten Jahren eine starke Zunahme von CA-MRSA bei Patienten ohne Risikofaktoren und ohne Kontakt zu medizinischen Einrichtungen beobachtet. In den USA sind CA-MRSA der häufigste Verursacher von ambulant erworbenen Haut-/Weichteilinfektionen geworden. In Deutschland sind CA-MRSA noch selten.

Ausblick. Wegen der Bedeutung von CA-MRSA für die allgemeine Gesundheit ist es notwendig, in Deutschland regelmäßige Studien zur Verbreitung von CA-MRSA durchzuführen. Medizinisches Personal muss über Krankheitsbilder, Diagnostik, Therapie und Prävention geschult sein. Infizierte und Träger sollten behandelt und der Trägerstatus saniert werden. Ziel ist es, die Verbreitung von CA-MRSA bestmöglich zu kontrollieren.

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