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Hospital-acquired and community-acquired MRSA in hospitals . 1 Hospital-acquired methicillin resistant s.aureus High percentage of hospital S.aureus isolates • has been found to be also resistant to methicillin or oxacillin. Antibiotic resistant is caused by chromosomal • acquisition of the gene for a modified penicillinbinding protein.This protein codes for a new peptidoglycan transpeptidase with a low affinity for all currently available beta-lactam antibiotics,and thus renders infections with methicillin-resistant S.aureus unresponsive to beta-lactam therapy. 2 Community –acquired methicillin –ristant • S.aureus: MRSA emerged in the community setting • occurring among young healthy individuals with no exposure to the healthcare setting.since then this CA-MRSA has rapidly spread throughout the world.Outbreaks of CA-MRSA have been reported among children,athletes,nurseries and obstertical wards. 3 . The patients in the hospital are divided into five compartments: • -number of susceptible patients. -number of patients colonized with the CA- MRSA • strain. -number of patients colonized with the HA- MRSA • strain. -number of patients infected with the CA-MRSA strain • -number of patients infected with the HA-MRSA strain. • 4 Estimated methicillin-resistant S.aureus MRSA-related hospitalization rates during 7 years 5 Pediatric pneumonia caused by CA-MRSA CA-MRSA, which carries genes for Panton- • Valentine leukocidin (PVL), has become a major concern worldwide. CA-MRSA is mainly associated with skin and soft tissue infections in young, otherwise healthy, persons in the community and also with life-threatening sepsis and community-acquired pneumonia (preceded ( by)6influenza). PVL, in combination with staphylococcal protein A, destroys respiratory tissue and bacteria-engulfing immune cells. 6 . Necrotizing Fasciitis is a life- • threatening infection of the superficial muscle fascia and adjacent subcutaneous tissue. staphylococcus aurous has been occasionally reported as a monomicrobial causative agent of necrotizing fasciitis and methicillin-resistant staphylococcus aureus was described as the cause of hospitalassociated necrotizing. 7 . Necrotizing fasciitis of the back caused by MRSA. The lower back showed erythematous lesions with skin necrosis. • 8 Some studies suggest that CA-MRSA will • become the dominant MRSA strain in the hospital setting and other studies shown that when no colonized or infected patients enter the hospital, competitive exclusion of HA-MRSA by CA-MRSA will occur with increased severity of CA-MRSA infections resulting in longer hospitalizations and a larger in-hospital reservoir of CA-MRSA. Improving compliance with hand hygiene and decolonization of CA-MRSA carriers .are effective control strategies. . 9 • . . 10