title: High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections.
abstract: OBJECTIVE
  We sought to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among emergency department (ED) patients with skin and soft tissue infections, identify demographic and clinical variables associated with MRSA, and characterize MRSA by antimicrobial susceptibility and genotype.
  
  
  METHODS
  This was a prospective observational study involving a convenience sample of patients who presented with skin and soft tissue infections to a single urban public hospital ED in California. Nares and infection site cultures were obtained. A health and lifestyle questionnaire was administered, and predictor variables independently associated with MRSA were determined by multivariate logistic regression. All S aureus isolates underwent antibiotic susceptibility testing. Eighty-five MRSA isolates underwent genotyping by pulsed field gel electrophoresis, staphylococcal chromosomal cassette mec (SCC mec ) typing, and testing for Panton-Valentine leukocidin genes.
  
  
  RESULTS
  Of 137 subjects, 18% were homeless, 28% injected illicit drugs, 63% presented with a deep or superficial abscess, and 26% required admission for the infection. MRSA was present in 51% of infection site cultures. Of 119 S aureus isolates (from infection site and nares), 89 (75%) were MRSA. Antimicrobial susceptibility among MRSA isolates was trimethoprim/sulfamethoxazole 100%, clindamycin 94%, tetracycline 86%, and levofloxacin 57%. Among predictor variables independently associated with MRSA infection, the strongest was infection type being furuncle (odds ratio 28.6). Seventy-six percent of MRSA cases fit the clinical definition of community associated. Ninety-nine percent of MRSA isolates possessed the SCC mec IV allele (typical of community-associated MRSA), 94.1% possessed Panton-Valentine leukocidin genes, and 87.1% belonged to a single clonal group (ST8:S).
  
  
  CONCLUSIONS
  In this urban ED population, MRSA is a major pathogen in skin and soft tissue infections. Although studies from other practice settings are needed, MRSA should be considered when empiric antibiotic therapy is selected for such infections.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center-Highland Campus, Oakland, CA 94602, USA. bradf_98@yahoo.com
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Frazee
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lynn
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Larry
authors.initials: L
authors.lastname: Lambert
authors.forename: Derrick
authors.initials: D
authors.lastname: Lowery
authors.forename: Francoise
authors.initials: F
authors.lastname: Perdreau-Remington
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D004636:Emergency Service, Hospital; D005260:Female; D005667:Furunculosis / Q000382:microbiology; D005838:Genotype; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D018461:Soft Tissue Infections / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D013207:Staphylococcal Skin Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D014504:Urban Health