Abstract
We report the primary care requirements and method for managing toxic shock syndrome (TSS) in areas where community-acquired infections with methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is rare, such as Japan. A 31-year-old male was visited a hospital because of a deep dermal burn of leg, partially deteriorated into deep burn. After eight days of treatment he was admitted to the hospital with the positive diagnostic criteria for TSS. A few days later, MRSA was cultured from the burned necrotic tissue. Analysis of the antibiotic susceptibility of the cultured MRSA indicated a susceptibility to sulfamethoxazole · trimethoprim or clindamycin. Genotyping of the MRSA, however, identified SCCmec type IV, thus comfirming CA-MRSA as the causal organism. TSS in Japan is much more frequently caused by the methicillin-susceptible Staphylococcus aureus infection than by CA-MRSA. Penicillin or cephalosporin with clindamycin is therefore considered the first-line therapy for TSS. The routine use of anti MRSA-agents should be avoided in an area such as Japan, where CA-MRSA infection is rare; however, we have to consider treatment with the anti-MRSA agents on the assumption of CA-MRSA infection. To prepare for the probable increase in the ratios of CA-MRSA infection, we must also carefully observe the epidemiological alteration of the CA-MRSA infection in Japan.
