Prevalence, Severity, and Treatment of Community-Acquired Methicillin-Resistant Staphylococcus Aureus (CA-MRSA) Skin and Soft Tissue Infections in 10 Medical Clinics in Texas: A South Texas Ambulatory Research Network (STARNet) Study

Abstract

OBJECTIVES Quantify the prevalence, measure the severity, and describe treatment patterns in patients who present to medical clinics in Texas with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft-tissue infections (SSTI). METHODS Ten primary care clinics participated in this prospective, community-based study. Clinicians consented patients and collected clinical information, pictures, and wound swabs; data were processed centrally. MRSASelect™ was used for identification. Susceptibilities were determined via Etest®. RESULTS Overall, 73/119 (61%) patients presenting with SSTIs meeting eligibility requirements had CA-MRSA. Among these, 49% were male, 79% were Hispanic, and 30% had diabetes. Half (56%) of the lesions were ≥ 5 cm in diameter. Most patients had abscesses (82%) and many reported pain scores of ≥ 7/10 (67%). Many presented with erythema (85%) or drainage (56%). Most received incision and drainage (I&D) plus an antibiotic (64%). Antibiotic monotherapy was frequently prescribed: trimethoprim-sulfamethoxazole (TMP-SMX) (78%), clindamycin (4%), doxycycline (2%), and mupirocin (2%). The rest received TMP-SMX in combination with other antibiotics. TMP-SMX was frequently administered as one double-strength tablet twice daily. Isolates were 93% susceptible to clindamycin and 100% susceptible to TMP-SMX, doxycycline, vancomycin, and linezolid. CONCLUSIONS We report a predominance of CA-MRSA SSTIs, favorable antibiotic susceptibilities, and frequent use of TMP-SMX in primary care clinics.

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

“…The prevalence observed in our study was lower than that observed in hospital-based studies, such as the study by Forcade et al 10 -performed in 10 primary care clinics in Texas, USA between 2001 and 2010 -in which MRSA was isolated from 73 (63%) of 119 patients with skin and soft tissue infections. Almeida et al 1 investigated the prevalence of S. aureus and MRSA in patients in a small hospital in Northeastern Brazil; they reported that 20% and 6.4% of wounds were colonized by S. aureus and MRSA, respectively.…”

“…We observed prevalence rates of 51.5% for S. aureus and 8.7% for MRSA; resistance to macrolides, lincosamides, aminoglycosides, and quinolones in sensitive and resistant isolates; and a higher frequency of SCCmec type IV MRSA, followed by type II. Studies addressing the prevalence of MRSA in primary care units are sparse 10 . In Brazil, only two such studies have been conducted; both were performed by the same research group in the City of Goiãnia, Goiás.…”

Clinico-microbiological study of community acquired and health care associated methicillin-resistant Staphylococcus aureus from skin and soft tissue infections

“…Similar results were obtained in a study on SSTIs due to CA-MRSA by Forcade et al where the predominant clinical presentation was a cutaneous abscess. 15 Literature on the subject reveals that CA-MRSA has a predilection for lower extremities and torso. 16,17 However in our study most of CA-MRSA infections presented as breast abscess (18.5%), the next common sites being the lower extremities (16.6%) and torso (13%).…”

Skin and Soft Tissue Infections

“…7,8 Increasing prevalence of MRSA as a cause of impetigo is indeed worrying. 9 Nasal colonization can act as a source of Staphylococcal impetigo. 10 …”