Antibiotics, skin and soft tissue infection and meticillin-resistant Staphylococcus aureus: cause and effect.

Staphylococcus aureus is not a new cause of skin and soft tissue infection, but the significance of the Panton-Valentine leukocidin toxin and the spread of several clones carrying different staphylococcal cassette chromosome (SCC) mecA gene cassette types have given it a new lease of life. This is a clinical area with several epidemic strains causing major problems around the world, most notably in the USA. While most attention focuses on treatment, prevention should be the goal. Traditional infection control measures, such as good hand hygiene and barrier precautions, are usually emphasised. Most importantly, we should not forget the underlying cause of meticillin-resistant Staphylococcus aureus (MRSA), namely antibiotic use. In both community and hospital, exposure to beta-lactams, in particular cephalosporins, and also sometimes quinolones and macrolides, is likely to promote the transmission, colonisation and increased virulence of MRSA. Future antibiotic policies should consider this, particularly in an era of widespread MRSA screening.