Enfermedad invasora por Staphylococcus aureus meticilino resistente adquirida en la comunidad

a 21 year old man, previously healthy, presented with subcutaneous nodes consistent with gummas. ultrasonography disclosed multiple subcutaneous abscesses and images suitable with piomiositis, pleural and pericardium effusion. a puncture-aspirate with fine-needle was performed and produced purulent material, with isolate of staphylococcus aureus. antimicrobial susceptibility testing by disk diffusion showed resistant to cefalotin, erythromycin and clindamycin, and susceptibility to trimethoprim-sulfamethoxazole, ciprofloxacin and rifampicin. methicilin-resistance was confirmed by staphyslide agglutination testing (biomérieux). the patient was treated with ciprofloxacin and rifampicin during four weeks, with a good clinical response. the frequency of ca-mrsa infections is increasing, and these are reported in patients without identified predisposing risks leading to failure on empiric therapy for community infections presumed to be due to staphylococcal agents.