sharon sanders
Editor-in-Chief & President
The Lancet Infectious Diseases 2006; 6:621
DOI:10.1016/S1473-3099(06)70588-6
MRSA becomes growing problem in US emergency departments
Khabir Ahmad
Meticillin-resistant Staphylococcus aureus (MRSA) is now the commonest cause of skin and soft-tissue infections presenting to emergency departments in the USA.
?The USA300 strain of MRSA has quickly emerged as the predominant cause of skin and soft tissue infections. MRSA infection is now common [even] in people who do not belong to any particular risk groups?, lead author Gregory Moran (UCLA Medical Center, Sylmar, CA) explained.
422 adults with skin and soft-tissue infections received by the 11 participating emergency departments across the USA in August 2004 were enrolled. S aureus was isolated from 320 patients (76%); MRSA accounted for 78% of S aureus isolates. 99% MRSA strains isolated had characteristics of community-associated MRSA. USA300 strain of MRSA accounted for 97% of MRSA isolates and 31% of meticillin-susceptible S aureus. Susceptibility of the pathogen to the prescribed antibiotics was not associated with patients' outcomes.
The next step, says Moran, is to identify the best possible treatment for these infections. ?But because community MRSA strains are susceptible to a number of older antibiotics that are available as generic drugs (eg, co-trimoxazole [trimethoprim-sulfamethoxazole], clindamycin, and doxycycline), there is not an impetus for drug companies to do comparative studies of outpatient treatment?, he explained.
According to Lindsay Grayson (University of Melbourne, Australia), the study shows how widespread the USA300 strain of MRSA has become throughout the USA population (or at least that section of the population that attends emergency departments), and highlights the importance of the basic principles of treating any infection?namely, drainage of purulent collections and/or removal of infected prosthetic material, accurate wound culture, and adjustment of empiric antibiotic therapy once the wound culture results are known. ?The staphylococcal treatment triangle is not equilateral, but is weighted in favour of surgical drainage and/or debulking as the principle therapeutic intervention?, she explained.
The results of this study, says Grayson, highlight the fact that clinicians can no longer simply assume that staphylococcal infections will be susceptible to beta-lactam anti-staphylococcal agents such as flucloxacillin or dicloxacillin. ?Instead we need to consider the role of other older agents such as trimethoprim-sulfamethoxazole and clindamycin. Newer agents such as fluoroquinolones are generally quite inappropriate for skin and soft tissue infections?, she concluded.
Click to enlarge image
Dr P Marazzi/Science Photo Library
DOI:10.1016/S1473-3099(06)70588-6
MRSA becomes growing problem in US emergency departments
Khabir Ahmad
Meticillin-resistant Staphylococcus aureus (MRSA) is now the commonest cause of skin and soft-tissue infections presenting to emergency departments in the USA.
?The USA300 strain of MRSA has quickly emerged as the predominant cause of skin and soft tissue infections. MRSA infection is now common [even] in people who do not belong to any particular risk groups?, lead author Gregory Moran (UCLA Medical Center, Sylmar, CA) explained.
422 adults with skin and soft-tissue infections received by the 11 participating emergency departments across the USA in August 2004 were enrolled. S aureus was isolated from 320 patients (76%); MRSA accounted for 78% of S aureus isolates. 99% MRSA strains isolated had characteristics of community-associated MRSA. USA300 strain of MRSA accounted for 97% of MRSA isolates and 31% of meticillin-susceptible S aureus. Susceptibility of the pathogen to the prescribed antibiotics was not associated with patients' outcomes.
The next step, says Moran, is to identify the best possible treatment for these infections. ?But because community MRSA strains are susceptible to a number of older antibiotics that are available as generic drugs (eg, co-trimoxazole [trimethoprim-sulfamethoxazole], clindamycin, and doxycycline), there is not an impetus for drug companies to do comparative studies of outpatient treatment?, he explained.
According to Lindsay Grayson (University of Melbourne, Australia), the study shows how widespread the USA300 strain of MRSA has become throughout the USA population (or at least that section of the population that attends emergency departments), and highlights the importance of the basic principles of treating any infection?namely, drainage of purulent collections and/or removal of infected prosthetic material, accurate wound culture, and adjustment of empiric antibiotic therapy once the wound culture results are known. ?The staphylococcal treatment triangle is not equilateral, but is weighted in favour of surgical drainage and/or debulking as the principle therapeutic intervention?, she explained.
The results of this study, says Grayson, highlight the fact that clinicians can no longer simply assume that staphylococcal infections will be susceptible to beta-lactam anti-staphylococcal agents such as flucloxacillin or dicloxacillin. ?Instead we need to consider the role of other older agents such as trimethoprim-sulfamethoxazole and clindamycin. Newer agents such as fluoroquinolones are generally quite inappropriate for skin and soft tissue infections?, she concluded.
Click to enlarge image
Dr P Marazzi/Science Photo Library