Methicillin-Resistant Infections Spread Like Wildfire

Methicillin-resistant Staphylococcus aureus (MRSA) has become the most common cause of skin and soft tissue infections, taking emergency room doctors back to the pre-penicillin days, when skin infections were lanced and drained, according to a new study.

Researchers from the Olive View-University of California Los Angeles Medical Center (OVMC-UCLA, Sylmar, CA, USA) prospectively looked at MRSA infections at 11 metropolitan centers in 2004. Specimens from 422 adult patients treated were cultured at each hospital using standard methods, and those found to be S aureus were sent to the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA) for further characterization. More than 75% of all skin and soft tissue infections treated were found to be colonized with S aureus, and 59% overall were methicillin-resistant. By comparison, MRSA was an uncommon cause of skin and soft tissue infections prior to 2000, hovering around 3%, depending on geographic location.

Although resistant to the antibiotic methicillin, most of the MRSA specimens were still susceptible to clindamycin (95%) and fluoroquinolones (60%). All were vulnerable to rifampin and trimethoprim-sulfamethoxazole. Only 6% were susceptible to erythromycin.

Most patients were treated with a combination of incision, drainage, and antibiotics (66%), another 10% received only antibiotics, and 19% underwent incision and drainage alone. Five percent received neither. The most commonly used antibiotics were antistaphylococcal penicillin and cephalosporin (64%). The study was published in the August 17, 2006, edition of the New England Journal of Medicine.

"MRSA is the most-common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments in 11 U.S. cities. When antimicrobial therapy is indicated for the treatment of skin and soft-tissue infections, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage,” concluded Gregory J. Moran, M.D., and colleagues from the OVMC.



Related Links:
Centers for Disease Control and Prevention
UCLA Medical Center