Prevalence and Use of Antibiotics in Community Associated Methicillin‐Resistant Staphylococcus aureus Infections (CA‐MRSA) in a Community Hospital

Background:

CA‐MRSA is a growing epidemic infection that has resulted in a transformation of the approach to skin and soft‐tissue infections. Although, CA‐MRSA differs from other MRSA infections in many ways, one difference that affects care is its sensitivity to older, less expensive antibiotics. We conducted this study to determine the prevalence of CA‐MRSA infections in our hospital and to assess the use of appropriate and cost‐effective antibiotics to treat this infection during admission and discharge.

Methods:

This was a retrospective chart review study performed in a community hospital in South Texas. Participants were 18 year or older with a positive culture for Staphylococcus aureus admitted through the emergency department during 2005. After this, patients with CA‐MRSA were identified based on the Alabama Department of Public Health criteria, 2005. The appropriateness of the antibiotic treatment was determined according to the “Strategies for Clinical Management of CA‐MRSA: Summary of an Experts' Meeting Convened by the Centers for Disease Control and Prevention” (March 2006).

Results:

We reviewed 501 charts of patients with positive Staphylococcus aureus cultures. Of those, 260 had MRSA, and 42 met criteria for CA‐MRSA skin infection. The prevalence of CA‐MRSA skin infections admitted to our hospital was 16%. Twenty‐six patients on admission (62%) and 38 patients on discharge (90.4%) were placed on adequate therapy. However, if we consider cost effectiveness, on discharge only 22 (52%) were given the most appropriate antibiotics.

Conclusions:

The high prevalence of CA‐MRSA infections in our hospital warranted empiric therapy. Once the culture sensitivities were known, many clinicians selected antibiotics that were effective against CA‐MRSA but were less cost effective in treating this organism. This study emphasized the importance of determining CA‐MRSA prevalence in all geographic areas and suggests that clinicians become more familiar with appropriate and cost‐effective treatments.

Author Disclosure:

P. Abanto, none; J. Hanley, none; J. Castillo, none.