Suspected methicillin-resistant Staphylococcus aureus infections at sea.
BACKGROUND
Methicillin-resistant Staphylococcus aureues (MRSA) has been increasingly reported as the cause of community acquired skin infections in individuals without established risk factors. MRSA infections have been reported in multiple settings, but not yet in the commercial maritime industry.


OBJECTIVE
To evaluate the incidence of skin and soft tissue infections at sea over the past 5 years, and to see if there are trends in reported clinical features that suggest MRSA as the pathogen.


METHODS
A retrospective chart review was undertaken of all cases reported from 2002 until 2006 to a single tele-medical advice service for ships at sea. Since microbiologic diagnosis is not feasible at sea, cases were evaluated for the following features which may suggest MRSA: the presence of pus, small abscess or furuncle, or suspected spider bite.


RESULTS
From 2002 to 2006 the percentage of cases that were skin infections rose from 5.5 to 8.8%. In 2002, 36% had features consistent with MRSA infection and 74 % had them in 2006 ( p <.05). Across all years approximately 25% of cases required an I&D procedure at sea or upon arrival in port.


CONCLUSIONS
The number of skin infections reported to a single tele-medical advice service has increased in the past five years. Furthermore, the proportion of cases with features common to MRSA infections doubled. Planners for health care at sea should consider stocking appropriate antibiotics for suspected MRSA and ensure medical officers are trained to perform I&D (incision and drainage) in order to treat this increasingly common skin infection.
Lucas
Raymond
R
Department of Emergency Medicine, The George Washington University, Washington, DC, USA. rlucas@mfa.gwu.edu
Boniface
Keith
K
Roberts
Karen
K
Kane
Elisabeth
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008712:Methicillin / Q000627:therapeutic use; D016106:Methicillin Resistance; D012189:Retrospective Studies; D012767:Ships; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014481:United States
D000900:Anti-Bacterial Agents; D008712:Methicillin