title: Risk factors for community-associated methicillin-resistant Staphylococcus aureus cellulitis--and the value of recognition.
abstract: OBJECTIVE
  To identify the risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cellulitis.
  
  
  METHODS
  A review of risk factors for CA-MRSA skin and soft tissue infection in previously published literature was first performed. A retrospective cohort study was then conducted in a teaching ambulatory-care clinic of a tertiary medical center in Honolulu, Hawaii.
  
  
  RESULTS
  Of 137 cases with cellulitis diagnosed from January 2005 to December 2007, MRSA was recovered from 85 (62%) of patients who presented with either abscesses or skin ulcers. The recovery of MRSA was significantly associated with obesity (p=0.01), presence of abscesses (p=0.01), and lesions involving the head and neck (p=0.04). Independent risk factors by multivariate logistic regression analysis included the presence of abscesses [adjusted odds ratio (aOR) 2.72; 95% confidence interval (CI) 1.27-5.83; p=0.01] and obesity (aOR 2.33; 95%; CI 1.10-4.97; p%0.03). Patients with CA-MRSA were less likely to receive an appropriate antibiotic (p=0.04) and were more likely to require antibiotic change at evaluation in one week (p=0.04) compared with patients infected with non-MRSA bacteria.
  
  
  CONCLUSIONS
  The presence of abscesses and obesity were significantly associated with CA-MRSA cellulitis. Empiric therapy with antibiotics active against MRSA should be guided by these risk factors.
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA. thanak30@yahoo.com
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.forename: Alan D
authors.initials: AD
authors.lastname: Tice
authors.forename: Andrew
authors.initials: A
authors.lastname: Grandinetti
authors.forename: Dominic
authors.initials: D
authors.lastname: Chow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002481:Cellulitis / Q000188:drug therapy / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006254:Hawaii; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult