Prior studies suggest that more than half of all skin and soft tissue infections (SSTIs) are caused by methicillin-resistant Staphylococcus aureus (MRSA). These data mainly represent inner-city urban centers.
We determined the bacteriologic etiologies and antibiotic susceptibilities from wound cultures in the emergency department (ED). We hypothesized that in a suburban ED, MRSA would not represent the major pathogen.
The study design was a retrospective, electronic medical record review in a suburban tertiary care ED with 80,000 annual visits. Subjects included ED patients of all ages who had skin or soft tissue cultures obtained in 2005–2008. Demographics and clinical data, including type of SSTI (MRSA or methicillin-sensitive S. aureus [MSSA]), culture results, and antibiotic susceptibility, were analyzed using descriptive statistics.
From the 1246 cultures obtained during the study period, 252 (20.2%) were MSSA and 270 (21.6%) were MRSA. The rates of MRSA infections over time increased from 13.5% to 25.7% during 2005–2008. The rates of MRSA in males and females were comparable at 23.3% and 19.6%, respectively. In 2008, MRSA was 97–100% susceptible to vancomycin, linezolid, rifampin, nitrofurantoin, chloramphenicol, gentamycin, tetracycline, and trimethoprim-sulfamethoxazole (TMP-SMZ). To a lesser extent it was susceptible to clindamycin (75%), erythromycin (62%), and levofloxacin (50%).
There has been a significant increase in the rates of MRSA SSTIs in a suburban ED, yet only 1 in 4 SSTIs are caused by MRSA. Both MRSA and MSSA are completely susceptible to vancomycin, linezolid, rifampin, nitrofurantoin, and chloramphenicol. Gentamicin, tetracycline, and TMP-SMZ cover > 97% of both isolates.
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- National epidemiology of cutaneous abscesses: 1996 to 2005.Am J Emerg Med. 2009; 27: 289-292
- National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infection.Arch Intern Med. 2008; 168: 1585-1591
- The changing epidemiology of Staphylococcus aureus?.Emerg Infect Dis. 2001; 7: 178-182
- Community acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk.JAMA. 1998; 279: 593-598
- Genome and virulence determinants of high virulence community acquired methicillin-resistant Staphylococcus aureus.Lancet. 2002; 359: 1819-1827
- Comparison of community and health care-associated methicillin-resistant Staphylococcus aureus infection.JAMA. 2003; 290: 2976-2984
- High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections.Ann Emerg Med. 2005; 45: 311-320
- Methicillin-resistant S. aureus infections among patients in the emergency department.N Engl J Med. 2006; 355: 666-674
- Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco.Clin Infect Dis. 2002; 34: 425-433
- Cutaneous methicillin-resistant Staphylococcus aureus rates in a suburban community hospital pediatric emergency department.J Emerg Med. 2008; 52: S73
- Methicillin-resistant Staphylococcus aureus disease in three communities.N Engl J Med. 2005; 352: 1436-1444
- Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus.Pediatr Infect Dis J. 2004; 23: 123-127
Published online: April 11, 2012
Accepted: August 28, 2011
Received in revised form: May 13, 2011
Received: November 22, 2010
Published by Elsevier Inc.