Cutaneous infections with community-acquired MRSA in aviators

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of growing concern among community-based practices in medicine, particularly those in the military. The risk of colonization and infection by community-acquired MRSA (CA-MRSA) is significantly higher among military members than that of the general population. The unique environment of the deployed, military aviator (impaired hygiene practices, close contact in warm, space-limited cockpits, and shared life support equipment) may increase risks of colonization, infection, and transmission of CA-MRSA and hence warrants the clinical attention of the flight surgeon. Studies of molecular genetics indicate that isolates of CA-MRSA contain a unique mobile genetic element (SCCmec type IV), indicating that CA-MRSA evolved separately from nosocomially acquired MRSA. Skin infections involving CA-MRSA are unlike their nosocomial counterparts in that CA-MRSA infections are susceptible to multiple classes of antibiotics and, on average, are clinically more aggressive. Awareness of this pathogen and appropriate clinical intervention can lead to prompt resolution of the infection and reduce rates of CA-MRSA colonization.