Skip to main content Accessibility help
×
Home

Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department

  • Robert Stenstrom (a1) (a2) (a3), Eric Grafstein (a1) (a2) (a3), Marc Romney (a4) (a3), John Fahimi (a3), Devin Harris (a1) (a4) (a3), Garth Hunte (a1) (a2) (a3), Grant Innes (a1) (a4) (a3) and Jim Christenson (a1) (a4) (a3)...

Abstract

Objective:

We sought to estimate the period prevalence of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) and evaluate risk factors for MRSA SSTI in an emergency department (ED) population.

Methods:

We carried out a cohort study with a nested case–control design. Patients presenting to our ED with a wound culture and a discharge diagnosis of SSTI between January 2003 and September 2004 were dichotomized as MRSA positive or negative. Fifty patients with MRSA SSTI matched by calendar time to 100 controls with MRSA-negative SSTI had risk factors assessed using multivariate conditional logistic regression.

Results:

Period prevalence of MRSA SSTI was 54.8% (95% confidence interval [CI] 50.2%–59.4%). The monthly period prevalence increased from 21% in January 2003 to 68% in September 2004 (p < 0.01). Risk factors for MRSA SSTI were injection drug use (IDU) (odds ratio [OR] 4.6, 95% CI 1.4–16.1), previous MRSA infection and colonization (OR 6.4, 95% CI 2.1–19.8), antibiotics in 8 weeks preceding index visit (OR 2.6, 95% CI 1.2–8.1), diabetes mellitus (OR 4.1, 95% CI 1.4–12.1), abscess (OR 5.6, 95% CI 1.8–17.1) and admission to hospital in previous 12 months (OR 2.6, 95% CI 1.1–11.2).

Conclusion:

The period prevalence of MRSA SSTI between January 2003 and September 2004 was 54.8% at our institution. There was a marked increase in the monthly period prevalence from the beginning to the end of the study. Risk factors are IDU, previous MRSA infection and colonization, prescriptions for antibiotics in previous 8 weeks and admission to hospital in the preceding 12 months. On the basis of local prevalence and risk factor patterns, emergency physicians should consider MRSA as a causative agent for SSTI.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department
      Available formats
      ×

Copyright

Corresponding author

Emergency Department, St. Paul's Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6; robstenstrom@shaw.ca

References

Hide All
1.Elston, DM. New and emerging diseases. J Am Acad Dermatol 2005;52:1062–8.
2.Eady, EA, Cove, JH. Staphylococcal resistance revisited: community-acquired methicillin-resistant Staphylococcus aureus — an emerging problem for the management of skin and soft tissue infections. Curr Opin Infect Dis 2003;16:103–24.
3.Nimmo, GR, Pearson, JC, Collignon, PJ, et al Prevalence of MRSA among Staphylococcus aureus isolated from hospital inpatients, 2005: report from the Australian Group for Antimicrobial Resistance. Commun Dis Intell 2007;31:288–96.
4.Miller, LG, Perdreau-Remington, GF, Rieg, G, et al Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352:1445–53.
5.Frazee, BW, Salz, TO, Lambert, L, et al Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult. Ann Emerg Med 2005;46:401–4.
6.Chang, WN, Lu, CH, Wu, JJ, et al Staphylococcus aureus meningitis in adults: a clinical comparison of infections caused by methicillin-resistant and methicillin-sensitive strains. Infection 2001;29:245–50.
7.Charlebois, ED, Bangsberg, DR, Moss, NJ, et al Population-based community prevalence of methicillin resistant Staphy-lococcus aureus in the urban poor of San Francisco. Clin Infect Dis 2002;34:425–33.
8.Frazee, BW, Lynn, J, Charlebois, ED, et al High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 2005;45:311–20.
9.Purcell, K, Fergie, J, Peterson, MD. Economic impact of the community-acquired methicillin-resistant Staphylococcus aureus epidemic on the Driscoll Children’s Health Plan. Pediatr Infect Dis J 2006;25:178–80.
10.Baillargeon, J, Kelley, MF, Leach, CT, et al Methicillin-resistant Staphylococcus aureus infection in the Texas Prison System. Clin Infect Dis 2004;38:92–5.
11.Lindenmayer, JM, Schoenfeld, S, O’Grady, R, et al Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895–9.
12.Groom, AV, Wolsey, DH, Naimi, TS, et al Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:1201–5.
13.Hosmer, DW, LeMeshow, S. Applied logistic regression. Toronto (ON): John Wiley and Sons; 1989.
14.Moran, GJ, Amii, RN, Abrahamian, FM, et al Methicillin-resistant staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005;11:928–30.
15.Moran, GJ, Krishnadasan, A, Gorwitz, J, et al Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–74.
16.Bartlett, M, McIntyre, L, Moseley, R, et al Methicillin-resistant S. aureus rates increase 260% in hospitals participating in HIP's international monitoring systems. Centers for Disease Control and National Center for Infectious Diseases Focus 2000;9:4.
17.Genestier, AL, Michallet, MC, Prevost, G, et al Staphylococcus aureus Panton-Valentine leukocidin directly targets mitochondria and induces Bax-independent apoptosis of human neutrophils. J Clin Invest 2005;115:3117–27.
18.Tacconelli, E, De Angelis, G, Cataldo, MA, et al Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008;61:2638.
19.Rajendran, PM, Young, D, Maurer, T, et al Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:4044–8.
20.Chavez-Bueno, S, Bozdogan, B, Katz, K, et al Inducible clindamycin resistance and molecular epidemiologic trends of pediatric community-acquired methicillin resistant Staphylococcus aureus in Dallas, Texas. Antimicrob Agents Chemother 2005;49:2283–8.
21.Stanaway, S, Johnson, D, Moulik, P, et al Methicillin-resistant Staphylococcus aureus (MRSA) isolation from diabetic foot ulcers correlates with nasal MRSA carriage. Diabetes Res Clin Pract 2007;75:4750.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed