title: National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.
abstract: BACKGROUND
  Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred.
  
  
  METHODS
  We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing.
  
  
  RESULTS
  Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increase; P < .001 for trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting.
  
  
  CONCLUSIONS
  The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, 3333 California St, San Francisco, CA 94143-0936, USA. hershad@peds.ucsf.edu
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Henry F
authors.initials: HF
authors.lastname: Chambers
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009819:Office Visits / Q000639:trends*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012874:Skin Diseases, Infectious / Q000188:drug therapy* / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents