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Community-Acquired MRSA Skin Infections: Not Uncommon
The prevalence of community-acquired MRSA infections might be reaching epidemic proportions.
Methicillin-resistant Staphylococcus aureus (MRSA) infections traditionally have been associated with exposure to healthcare settings, but now the prevalence of community-acquired MRSA infections is increasing in some U.S. locations. Two recent reports add to the body of evidence.
In one study, conducted in 2003 at a large public hospital in Atlanta, researchers used laboratory surveillance and medical record reviews to identify 389 episodes of community-onset S. aureus skin and soft-tissue infections. Seventy-two percent of the episodes were caused by MRSA, and 28% were caused by methicillin-sensitive S. aureus (MSSA). Of the 159 community-acquired MRSA isolates available for specialized testing, 99% were from a single clone known as USA 300, and 1% were from the USA 400 clone. Among the patients with USA 300/400 isolates, only 18% had been hospitalized in the past 12 months.
In the other study, researchers examined the prevalence of S. aureus colonization by examining culture results from nasal swabs taken in 2001 and 2002 from a representative sample of children and adults in the U.S. Of 9622 participants, 31.6% were colonized with MSSA, and 0.8% were colonized with MRSA.
Comment: An editorialist calls MRSA infection an epidemic in the U.S. and suggests that nasal carriage might not be the prime predictor of community-acquired MRSA infections. He recommends using drugs with activity against community-acquired MRSA (e.g., doxycycline, trimethoprim-sulfamethoxazole, clindamycin) when patients don’t respond to standard drugs or in areas with high prevalences of community-acquired MRSA. For infections that are particularly invasive, he recommends vancomycin or linezolid.
— Richard Saitz, MD, MPH, FACP, FASAM
Dr. Saitz is Professor of Medicine and Epidemiology, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University Schools of Medicine and Public Health.
Published in Journal Watch Dermatology April 11, 2006
Originally published in Journal Watch March 31, 2006
Citation(s):
King MD et al. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006 Mar 7; 144:309-17.
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Graham PL III et al. A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med 2006 Mar 7; 144:318-25.
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- Medline abstract (Free)
Moellering RC Jr. The growing menace of community-acquired methicillin-resistant Staphylococcus aureus. Ann Intern Med 2006 Mar 7; 144:368-70.
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- Medline abstract (Free)