Pediatricians' perspectives on the impact of MRSA in primary care: a qualitative study.
BACKGROUND
The incidence of skin and soft-tissue infections (SSTIs) has rapidly increased among children in primary care settings since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Recent treatment recommendations emphasize CA-MRSA as the primary cause, performing incision and drainage (I&D) as the primary therapy, and not prescribing antibiotics for uncomplicated cases. It is unknown how this epidemic has impacted primary care pediatricians in terms of their practice patterns and barriers they face to providing recommended therapies.


METHODS
3 Focus groups among 29 primary care pediatricians in the San Francisco Bay Area were conducted. Transcripts were reviewed and coded into major themes by two investigators using modified grounded theory.


RESULTS
Substantial changes in clinical practice have occurred since the emergence of CA-MRSA. These include increased office visits for SSTIs, patients with multiple recurrences and transmission within households. Additionally, our participants reported increased visits for mild skin problems due to media reports contributing to fears about CA-MRSA. Participants routinely prescribed antibiotics for SSTIs, however, few performed I&D. Few were aware of recent SSTI treatment recommendations. Barriers to prescribing antibiotics with CA-MRSA activity included concerns about side-effects and lack of local epidemiologic data showing that it is the primary etiology. Barriers to performing I&D included lack of training, resources and skepticism about its necessity. Important clinical challenges included increased time demands for follow-up visits and patient education along with the lack of evidence-based strategies for preventing recurrent infections and household transmission.


CONCLUSIONS
CA-MRSA has influenced the presentation and treatment of SSTIs especially in terms of case numbers and recurrences. Barriers to providing recommended therapies can be addressed through improved dissemination of treatment guidelines and epidemiologic data. Studies are urgently needed to improve the evidence-base for treatment and prevention strategies.
Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA. hershad@peds.ucsf.edu
Adam L
AL
Hersh
Michael D
MD
Cabana
Ralph
R
Gonzales
Budd N
BN
Shenkin
Christine S
CS
Cho
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002648:Child; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000523:psychology* / Q000601:surgery; D019468:Disease Management; D004322:Drainage; D005192:Family Health; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010372:Pediatrics; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011364:Professional Practice / Q000706:statistics & numerical data; D012008:Recurrence; D012495:San Francisco / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000523:psychology / Q000601:surgery; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000523:psychology* / Q000601:surgery; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000523:psychology / Q000601:surgery
D000900:Anti-Bacterial Agents