Abstract
Background
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.
Objective
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.
Methods
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.
Results
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%).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: April 11, 2012
Accepted:
August 28,
2011
Received in revised form:
May 13,
2011
Received:
November 22,
2010
Identification
Copyright
Published by Elsevier Inc.
