BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred. METHODS: We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing. RESULTS: Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increase; P < .001 for trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting. CONCLUSIONS: The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.
BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred. METHODS: We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing. RESULTS: Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increase; P < .001 for trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting. CONCLUSIONS: The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.
Authors: Batu K Sharma-Kuinkel; Yuling Wu; David E Tabor; Hoyin Mok; Bret R Sellman; Amy Jenkins; Li Yu; Hasan S Jafri; Thomas H Rude; Felicia Ruffin; Wiley A Schell; Lawrence P Park; Qin Yan; Joshua T Thaden; Julia A Messina; Vance G Fowler; Mark T Esser Journal: J Clin Microbiol Date: 2014-11-12 Impact factor: 5.948
Authors: Shirish Balachandra; Maria Pardos de la Gandara; Scott Salvato; Tracie Urban; Claude Parola; Chamanara Khalida; Rhonda G Kost; Teresa H Evering; Mina Pastagia; Brianna M D'Orazio; Alexander Tomasz; Herminia de Lencastre; Jonathan N Tobin Journal: Microb Drug Resist Date: 2015-02-10 Impact factor: 3.431
Authors: Ryan C Johnson; Michael W Ellis; Jeffrey B Lanier; Carey D Schlett; Tianyuan Cui; D Scott Merrell Journal: Infect Immun Date: 2014-12-08 Impact factor: 3.441
Authors: Chen Song; Conrad Weichbrodt; Evgeniy S Salnikov; Marek Dynowski; Björn O Forsberg; Burkhard Bechinger; Claudia Steinem; Bert L de Groot; Ulrich Zachariae; Kornelius Zeth Journal: Proc Natl Acad Sci U S A Date: 2013-02-20 Impact factor: 11.205