Toxicokinetics of voriconazole during massive intentional poisoning.

the meantime had developed a rhinitis and an ulcer on the right eye, were taken by the local medical staff. In July 2008, samples taken from the mother-in-law's foot ulcer as well as from the corneal ulcer and the throat of the dog were found to be positive for MRSA. Further analysis of these three MRSA strains and the one from the initial screening at the Small Animal Clinic was performed as described in Case 1. All four MRSA strains carried the gene mecA on an SCCmec type II cassette and were PVL-negative. The strains were resistant to penicillins (penicillin G, 16 mg/L; ampicillin, !8 mg/L; and oxacillin 8 mg/L), erythromycin (!64 mg/L), clindamycin (!128 mg/L) and enro-floxacin (!32 mg/L). All isolates exhibited spa type t014 and MLST type ST225 (allelic profile 1-4-1-4-12-25-10). For all four strains indistinguishable macrorestriction patterns were generated by using the enzymes SmaI as well as ApaI (Figure 1a and b). Based on the epidemiological background data, the most likely route of transmission of the MRSA ST398 strain in Case 1 was from pigs to the veterinarian and subsequently from the veterinarian to his dog. MRSA ST398 strains have been reported to have their main reservoir in pigs, although such strains also occur in other animals and humans. 9,10 The transfer of MRSA ST398 strains from colonized swine to swine farmers and veterinarians , and then further on to their family members has also been documented. 11 Case 1 extends these observations by showing that pets sharing the same household may also become colonized. In Case 2, the mother-in-law appeared to be the source of the MRSA ST225 strain. Since the mother-in-law had not been tested for MRSA carriage prior to this study, it is not known for how long she had been carrying the strain. MRSA ST225 strains have frequently been found in humans, either as colonizers or as cause of infection. 17_09.pdf), ST225 strains were the second most frequently detected MRSA strains among humans in Germany in 2007 and 2008. In contrast, MRSA ST225 strains have not been detected so far in dogs. 5,6 These two case reports show that MRSA strains of different sequence types are readily transferred between humans and pets living in the same household. Moreover, these observations point towards the role of colonized pets as vectors of MRSA strains.