title: The increasing problem of wound bacterial burden and infection in acute and chronic soft-tissue wounds caused by methicillin-resistant Staphylococcus aureus.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has become a leading cause of colonization and infection in both acute and chronic soft-tissue wounds.
  
  
  OBJECTIVE
  Our objective is to define this current epidemic problem caused by both community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA), focusing on the similarities and differences between these 2 isolates as well as the impact on wound management decisions.
  
  
  METHODS
  Methods used include a literature review on the growth of the current MRSA problem and its International scope. In addition, a current up-to-date assessment had been made of the problem and the current approach to management of MRSA in acute soft-tissue and chronic wounds. Burns are not discussed because this injury usually does not fit either categories and is managed quite uniquely.
  
  
  RESULTS
  Results included the following: (1) There are very distinct properties of CA-MRSA and HA-MRSA, which must be considered for acute and chronic wound care. Management of both requires rigorous barrier precaution techniques to avoid cross-contamination. The presence of MRSA as a carrier state increases the risk of both a systemic and local wound infection in the carrier. There are large and increasing reservoirs of CA-MRSA and HA-MRSA worldwide leading to more bacteremias and wound problems. Topical antimicrobial therapy has not been addressed in managing MRSA in acute and chronic wounds.
  
  
  CONCLUSIONS
  Conclusions include the fact that both HA-MRSA and CA-MRSA wound infections are rapidly increasing, especially with CA-MRSA. This high incidence requires appropriate wound prediction and management decisions as well as attempts to avoid further cross-contamination and reservoir growth. Topical antimicrobial therapy would seem to be an important component in controlling this tremendous problem. Yet this topic has yet to be adequately addressed.
authors: Brigham and Women's Hospital, Burn and Trauma Center, Boston, MA, USA. rhdemling@partners.org
authors: Robert H
authors: RH
authors: Demling
authors: Barbara
authors: B
authors: Waterhouse