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Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA): an affliction of the underclass

Published online by Cambridge University Press:  11 May 2015

Joseph V. Vayalumkal ,
Kathryn N. Suh ,
Baldwin Toye ,
Karamchand Ramotar ,
Raphael Saginur  and
Virginia R. Roth
Joseph V. Vayalumkal
Affiliation:
Department of Pediatrics, Section of Infectious Diseases, Alberta Children's Hospital, University of Calgary, Calgary, AB
Kathryn N. Suh
Affiliation:
Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, ON
Baldwin Toye
Affiliation:
Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, ON Department of Pathology and Laboratory Medicine, Division of Microbiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Karamchand Ramotar
Affiliation:
Department of Pathology and Laboratory Medicine, Division of Microbiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Raphael Saginur
Affiliation:
Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, ON
Virginia R. Roth*
Affiliation:
Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, ON
*
Infection Prevention and Control, The Ottawa Hospital, General Campus Room G-12, 501 Smyth Road, Ottawa, ON K1H 8L6; vroth@ottawahospital.on.ca.

Abstract

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Objective:

The objective of this study was to determine whether skin and soft tissue infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) in patients presenting to The Ottawa Hospital emergency departments (TOHEDs) differed from SSTIs caused by methicillin-susceptible Staphylococcus aureus (MSSA) with regard to risk factors, management, and outcomes.

Methods:

All patients seen at TOHEDs in 2006 and 2007 with SSTIs who yielded MRSA or MSSA in cultures from the site of infection were eligible for inclusion. We excluded patients with decubitus ulcers and infections related to diabetes or peripheral vascular disease. We used an unmatched case-control design. Cases were defined as patients with MRSA isolated from the infection site, and controls were defined as patients with MSSA isolated from the infection site. Data were collected retrospectively from health records and laboratory and hospital information systems.

Results:

A total of 153 patients were included in the study (81 cases and 72 controls). The mean age of cases was 37 years, compared to 47 years for the controls (p < 0.001). Cases were more likely to have transient residence (31% v. 3% [OR 15.6, 95% CI 3.9–61.8, p < 0.001]), present with abscesses (64% v. 15% [OR 9.9, 95% CI 4.3–23.7, p < .001]), have a documented history of hepatitis C infection (28% v. 3% [OR 13.9, 95% CI 3.9–55.0, p < 0.001]), and have a history of substance abuse (53% v. 10% [OR 10.5, 95% CI 4.4–25.1, p < 0.001]). Cases most commonly used crack cocaine and injection drugs.

Conclusion:

SSTIs caused by MRSA at TOHEDs mainly occur in a population that is young and transient with comorbidities such as hepatitis C and substance abuse.

Keywords

methicillin-resistant Staphylococcus aureus (MRSA)skin and soft tissue infectionsmethicillin-susceptible Staphylococcus aureus
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 6 , November 2012 , pp. 335 - 343
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

REFERENCES

1.Taylor, G, Kirkland, T, Kowalewska-Grochowska, K, et al. A multistrain cluster of methicillin-resistant Staphylococcus aureus based in a native community. Can J Infect Dis Med Microbiol 1990;1:121–6.Google Scholar
2.Shahin, R, Johnson, IL, Jamieson, F, et al. Methicillin-resistant Staphylococcus aureus carriage in a child care center following a case of disease. Toronto Child Care Center Study Group. Arch Pediatr Adolesc Med 1999;153:864–8.CrossRefGoogle Scholar
3.Gilbert, M, Macdonald, J, Gregson, D, et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006;175:149–54, doi:10.1503/cmaj.051565.Google Scholar
4.Main, CL, Jayaratne, P, Haley, A, et al. Outbreaks of infection caused by community-acquired methicillin-resistant Staphylococcus aureus in a Canadian correctional facility. Can J Infect Dis Med Microbiol 2005;16:343–8.CrossRefGoogle Scholar
5.Pallin, DJ, Egan, DJ, Pelletier, AJ, et al. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med 2008;51:291–8, doi:10.1016/j.annemergmed.2007.12.004.CrossRefGoogle ScholarPubMed
6.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillinresistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–74, doi:10.1056/NEJMoa055356.CrossRefGoogle ScholarPubMed
7.Moran, GJ, Amii, RN, Abrahamian, FM, et al. Methicillinresistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005;11:928–30, doi:10.3201/eid1106.040641.Google Scholar
8.Adam, HJ, Allen, VG, Currie, A, et al. Community-associated methicillin-resistant Staphylococcus aureus: prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors. CJEM 2009;11:439–46.CrossRefGoogle ScholarPubMed
9.Al-Rawahi, GN, Reynolds, S, Porter, SD, et al. Communityassociated CMRSA-10 (USA-300) is the predominant strain among methicillin-resistant Staphylococcus aureus strains causing skin and soft tissue infections in patients presenting to the emergency department of a Canadian tertiary care hospital. J Emerg Med 2010;38:6–11, doi:10.1016/j.jemermed.2007.09.030.CrossRefGoogle Scholar
10.Charlebois, M, Lau, W, MacDonald, J, et al. Enhanced population-based surveillance for CMRSA10 (USA300) in a large Canadian health region. Poster session presented at the CHICA Canada National Education Conference; 2007 Jun 9–14; Edmonton, AB.Google Scholar
11.Jessamine, P, Ramotar, K, Desjardins, M, et al. Clinical and epidemiologic features of patients with CMRSA-7 or CMRSA-10 at a tertiary care hospital. Poster session presented at the AMMI Canda-CACMID Annual Conference; 2007 Mar 14–18; Halifax NS.Google Scholar
12.Ramotar, K, Desjardins, M, Roth, V, et al. Trends in the molecular epidemiology of methicillin resistant Staphylococcus aureus (MRSA) in eastern Ontario (EO). Poster session presented at the AMMI Canda-CACMID Annual Conference; 2007 Mar 14–18; Halifax, NS.Google Scholar
13.Stenstrom, R, Grafstein, E, Romney, M, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department. CJEM 2009;11:430–8.Google Scholar
14.Adlaf, EM, Begin, P, Sawka, E, editors. Canadian Addiction Survey (CAS): a national survey of Canadians’ use of alcohol and other drugs: prevalence of use and related harms: detailed report. Ottawa: Canadian Centre on Substance Abuse, Health Canada; 2005.Google Scholar
15.Embil, J, Ramotar, K, Romance, L, et al. Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies 1990–1992. Infect Control Hosp Epidemiol 1994;15:646–51, doi:10.1086/646827.Google ScholarPubMed
16.Lina, G, Piémont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128–32, doi:10.1086/313461.CrossRefGoogle ScholarPubMed
17.Oliveira, DC, Tomasz, A, de Lencastre, H. Secrets of success of a human pathogen: molecular evolution of pandemic clones of methicillin-resistant Staphylococcus aureus. Lancet Infect Dis 2002;2:180–9, doi:10.1016/S1473-3099(02)00227-X.CrossRefGoogle Scholar
18.Duong, M, Markwell, S, Peter, J, et al. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010;55:401–7, doi:10.1016/j.annemergmed.2009.03.014.CrossRefGoogle ScholarPubMed
19.Schmitz, GR, Bruner, D, Pitotti, R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med 2010;56:283–7, doi:10.1016/j.annemergmed.2010.03.002.Google Scholar
20.Golding, GR, Levett, PN, McDonald, RR, et al. A comparison of risk factors associated with community-associated methicillin-resistant and -susceptible Staphylococcus aureus infections in remote communities. Epidemiol Infect 2010;138:730–7, doi:10.1017/S0950268809991488.CrossRefGoogle ScholarPubMed
21.Skiest, DJ, Brown, K, Cooper, TW, et al. Prospective comparison of methicillin susceptible and methicillinresistant community-associated Staphylococcus aureus infections in hospitalized patients. J Infect 2007;54:427–34, doi:10.1016/j.jinf.2006.09.012.CrossRefGoogle ScholarPubMed
22.Davis, SL, Perri, MB, Donabedian, SM, et al. Epidemiology and outcomes of community-associated methicillin-resistant Staphylococcus aureus infection. J Clin Microbiol 2007;45:1705–11, doi:10.1128/JCM.02311-06.CrossRefGoogle ScholarPubMed