NYMC Faculty Publications

Antibiotics for Methicillin-Resistant Staphylococcus Aureus Skin and Soft Tissue Infections: The Challenge of Outpatient Therapy

Author Type(s)

Faculty

DOI

10.1016/j.ajem.2013.10.026

Journal Title

The American Journal of Emergency Medicine

First Page

135

Last Page

138

Document Type

Article

Publication Date

2-1-2014

Department

Emergency Medicine

Keywords

Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Cephalexin, Child, Child, Preschool, Clindamycin, Drug Resistance, Multiple, Bacterial, Drug Therapy, Combination, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Retrospective Studies, Soft Tissue Infections, Staphylococcal Skin Infections, Trimethoprim, Sulfamethoxazole Drug Combination, Young Adult

Disciplines

Medicine and Health Sciences

Abstract

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming increasingly prevalent in both community and hospital settings. Certain strains are notorious for causing skin and soft tissue infections in patients with no established risk factors. In this article, we report our findings on the dynamic antibiotic resistance pattern of MRSA and outpatient prescription trend for skin and soft tissue infections within our community.

METHODS: We conducted a retrospective medical record review of 1876 patients evaluated in the emergency department of an urban community hospital from 2003 to 2012. Data regarding culture isolates and associated antimicrobial resistance, antibiotic treatment, site of specimen collection, age, race, and sex were collected and analyzed.

RESULTS: Analysis of 1879 culture specimens yielded 2193 isolates. In some cases, a single specimen yielded polymicrobial growth. Staphylococcus aureus represented 996 isolates (45.4%); 463 were methicillin-susceptible (21.1%) and 533 (24.3%) were methicillin-resistant. Most patients were prescribed a single- or poly-drug regimen of trimethoprim/sulfamethoxazole, cephalexin, and clindamycin. Antimicrobial resistance analysis indicated that MRSA became increasingly resistant to the aforementioned antibiotics over time: 10% and 6% in 2012 vs 3.5% and 3.4% in 2007 for clindamycin and trimethoprim/sulfamethoxazole, respectively.

CONCLUSION: Methicillin-resistant Staphylococcus aureus is a particularly virulent, rapidly adaptive pathogen that is becoming increasingly difficult to combat with existing antibiotics. Care must be taken to ensure appropriate treatment and follow-up of patients with known MRSA infections.

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