title: Prevalence, severity, and treatment of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections in 10 medical clinics in Texas: a South Texas Ambulatory Research Network (STARNet) study.
abstract: OBJECTIVE
  Quantify the prevalence, measure the severity, and describe treatment patterns in patients who present to medical clinics in Texas with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft-tissue infections (SSTI).
  
  
  METHODS
  Ten primary care clinics participated in this prospective, community-based study. Clinicians consented patients and collected clinical information, pictures, and wound swabs; data were processed centrally. MRSASelect™ was used for identification. Susceptibilities were determined via Etest®.
  
  
  RESULTS
  Overall, 73 of 119 (61%) patients presenting with SSTIs meeting eligibility requirements had CA-MRSA. Among these, 49% were male, 79% were Hispanic, and 30% had diabetes. Half (56%) of the lesions were ≥ 5 cm in diameter. Most patients had abscesses (82%) and many reported pain scores of ≥ 7 of 10 (67%). Many presented with erythema (85%) or drainage (56%). Most received incision and drainage plus an antibiotic (64%). Antibiotic monotherapy was frequently prescribed: trimethoprim-sulfamethoxazole (TMP-SMX) (78%), clindamycin (4%), doxycycline (2%), and mupirocin (2%). The rest received TMP-SMX in combination with other antibiotics. TMP-SMX was frequently administered as one double-strength tablet twice daily. Isolates were 93% susceptible to clindamycin and 100% susceptible to TMP-SMX, doxycycline, vancomycin, and linezolid.
  
  
  CONCLUSIONS
  We report a predominance of CA-MRSA SSTIs, favorable antibiotic susceptibilities, and frequent use of TMP-SMX in primary care clinics.
authors: College of Pharmacy, University of Texas, Austin, TX, USA.
authors: Nicolas A
authors: NA
authors: Forcade
authors: Michael L
authors: ML
authors: Parchman
authors: James H
authors: JH
authors: Jorgensen
authors: Liem C
authors: LC
authors: Du
authors: Natalie R
authors: NR
authors: Nyren
authors: Lucina B
authors: LB
authors: Treviño
authors: Joel
authors: J
authors: Peña
authors: Michael W
authors: MW
authors: Mann
authors: Abilio
authors: A
authors: Muñoz
authors: Sylvia B
authors: SB
authors: Treviño
authors: Eric M
authors: EM
authors: Mortensen
authors: Brian L
authors: BL
authors: Wickes
authors: Brad H
authors: BH
authors: Pollock
authors: Christopher R
authors: CR
authors: Frei
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin