First fatal infection due to c-MRSA in Austria

Abstract number: 1734_132

Zimmermann A., Mittermayer H., Hell M., Wimmer F., Lenzhofer R., Pauser G.

Objectives: Community aquired MRSA (c-MRSA) infections are registered since the year 2002 in Austria. In our region in the middle of Austria (county of Salzburg) c-MRSA is investigated for its PVL-positivity systematically since 2004. The typing is done in a reference laboratory in Linz.

We report the first fatal infection due to an PVL-positive MRSA in a 34-year old woman in Austria from our region in 2005. Returning from a home holiday from the Philippines she developed high fever being pregnant 2 weeks before delivery. A cesarian section was performed in the local hospital. The patient developed a foudroyant pneumonia and for that reason was transferred to the next teaching hospital.

After 10 days intensive care treating pneumonia was still progredient and therefore she was transferred to the university hospital Salzburg. Antimicrobial therapy was switched from Amoxi/clavulanic acid to Linezolid + Imipenem + Clarythromycin. Pneumonia was accompanied by abscess formation in the lung under this regimen. After another day of treatment she died unfortunatly due to a septic shock and multi-organ failure.

Methods: Routine samples were taken from the tracheal secretions during intensive care treatment. MRSA was found in the first samples and also viral investigations were done. The MRSA isolate was investigated for PVL (Panton-Valentine Leukocidin) and subtyping was performed.

Results: Lung abscesses and necrotising pneumonia were due to a superinfection with a PVL-positive MRSA-ST30-subtype 2 (south westpacific clone). Underlying disease was caused by a influenza A infection. During hospitalisation in all 3 hospitals no transmission of this MRSA was obvious.

Conclusion: This was the first time in our country such a severe infection due to PVL-positive MRSA was seen. Severe community acquired pneumonia has to be redefined in its therapeutic strategies including now also multiresistant organsisms such as c-MRSA.