Cutaneous Community‐associated Methicillin‐resistant <i>Staphylococcus aureus</i> among All Skin and Soft‐tissue Infections in Two Geographically Distant Pediatric Emergency Departments

Hasty, Molly B.; Klasner, Ann; Kness, Sean; Denmark, T. Kent; Ellis, Don; Herman, Martin I.; Brown, Lance

doi:10.1197/j.aem.2006.08.008

Cited by 32 publications

(3 citation statements)

References 33 publications

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“…Among 389 patients in a Georgia health system, 72% of all S. aureus SSTIs were caused by MRSA, and ϳ85% of these were caused by USA300. Similar findings were seen concurrently in cohorts of patients presenting to emergency departments elsewhere in the United States (266)(267)(268)(269)(270).…”

Section: Epidemiologysupporting

confidence: 69%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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Section: Epidemiologysupporting

confidence: 69%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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“…The majority of these infections may represent simple cutaneous abscesses, which generally do not require antibiotic therapy, but rather incision and drainage alone, as demonstrated by multiple trials [3, 18–22]. Furthermore, many of these infections may be due to community acquired MRSA (CA-MRSA), which is more often susceptible to a greater number of antibiotic classes than is healthcare associated MRSA (HA-MRSA), and may therefore obviate the need for vancomcyin in many cases [2, 23]. …”

Section: Discussionmentioning

confidence: 99%

Emergency Department Vancomycin Use: Dosing Practices and Associated Outcomes

Fuller¹,

Mohr²,

Skrupky³

et al. 2013

The Journal of Emergency Medicine

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Background Emergency department (ED) dosing of vancomycin and its effect on outcomes has not been examined. Study objective To describe current vancomycin dosing practices for ED patients, focusing on patient factors associated with administration, dosing accuracy based on patient body weight, and clinical outcomes. Methods Single center, retrospective cohort study of vancomycin administered in the ED over 18 months in an academic, tertiary care ED. Data were collected on 4,656 patients. Data were analyzed using a generalized estimating equations GEE) model to account for multiple doses being administered to the same patient. Results The ED dose was continued, unchanged, in 2,560 admitted patients (83.8%). The correct dose was given 980 times (22.1%), 3,143 doses (70.7%) were under dosed, and 318 were overdosed (7.2%). Increasing weight was associated with under dosing (adjusted odds ratio 1.52 per 10 kg body weight, p < 0.001). Doses of vancomycin >20 mg/kg had longer hospital length of stay, p = 0.005, were more likely to spend ≥ 3 days in the hospital, OR 1.49 (1.12, 1.98, p = 0.006), and to die, OR 1.88 (1.22, 2.90, p = 0.004). Conclusion In this largest study to date examining ED vancomycin dosing, vancomycin was commonly given. Dosing outside the recommended range was frequent, and especially prevalent in patients with a higher bodyweight. The ED dose of vancomycin was frequently continued as an inpatient, regardless of dosing accuracy. There is significant room for improvement in dosing accuracy and indication. Vancomycin dosing in the ED may also affect clinical outcomes.

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“…48.2%, in our case series presenting with S. aureus CAPhad a documented recent history of skin and soft tissue infection. S. aureus CAP is usually associated with soft tissue superficial infections [98]; mild injuries usually precede community-acquired S. aureus infections and are the portal of entry for invasion [31,99]. In our analysis, however, skin and soft tissue infections did not reach statistical significance (p = 0.530), suggesting that skin and soft tissue infection was not associated with death, which was different from the findings of other studies [14,15].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

Zhang²,

Huang³

et al. 2010

Respiration

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Background: Although community-acquired Staphylococcus aureus pneumonia with highly virulent Panton-Valentine leukocidin (PVL)-positive strains, a severe disease with significant lethality, is rare, especially in adult and adolescent patients, recent reports highlight that these infections are on the rise. Objectives: To describe the demographic and clinical features of reported cases of life-threatening community-acquired S. aureus pneumonia with usually PVL-positive strains in adult and adolescent patients, to evaluate the variables related to death, and to select a more appropriate antimicrobial treatment for this potentially deadly disease. Methods: We summarized all of the 92 reported cases and our case. The effect of 5 variables on mortality was measured using logistic regression. Results:S. aureus community-acquired pneumonia (CAP) with usually PVL-positive strains is a severe disease with significant lethality, i.e. 42.9%; a short duration of the time from the onset of symptoms to death, i.e. 5.5 ± 10.1 days, and prolonged hospital admissions, i.e. 33.2 ± 29.5 days. Seventy-three cases have been tested for the gene for PVL, and 71 strains have been found to carry the PVL gene. Logistic regression analysis showed that leucopenia (p = 0.002), influenza-like symptoms or laboratory-confirmed influenza (p = 0.011), and hemoptysis (p = 0.024) were the factors associated with death. Antibiotic therapies inhibiting toxin production were associated with an improved outcome in these cases (p = 0.007). Conclusions: Physicians should pay special attention to those patients who acquired severe CAP during influenza season and have flu-like symptoms, hemoptysis, and leucopenia, and they should consider S. aureus more frequently among the possible pathogens of severe CAP. Empiric therapy for severe CAP with this distinct clinical picture should include coverage for S. aureus. Targeted treatment with antimicrobials inhibiting toxin production appears to be a more appropriate selection.

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Cutaneous Community‐associated Methicillin‐resistant Staphylococcus aureus among All Skin and Soft‐tissue Infections in Two Geographically Distant Pediatric Emergency Departments

Cited by 32 publications

References 33 publications

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Emergency Department Vancomycin Use: Dosing Practices and Associated Outcomes

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

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