title: MRSA rates and antibiotic susceptibilities from skin and soft tissue cultures in a suburban ED.
abstract: BACKGROUND
  Prior studies suggest that more than half of all skin and soft tissue infections (SSTIs) are caused by methicillin-resistant Staphylococcus aureus (MRSA). These data mainly represent inner-city urban centers.
  
  
  OBJECTIVE
  We determined the bacteriologic etiologies and antibiotic susceptibilities from wound cultures in the emergency department (ED). We hypothesized that in a suburban ED, MRSA would not represent the major pathogen.
  
  
  METHODS
  The study design was a retrospective, electronic medical record review in a suburban tertiary care ED with 80,000 annual visits. Subjects included ED patients of all ages who had skin or soft tissue cultures obtained in 2005-2008. Demographics and clinical data, including type of SSTI (MRSA or methicillin-sensitive S. aureus [MSSA]), culture results, and antibiotic susceptibility, were analyzed using descriptive statistics.
  
  
  RESULTS
  From the 1246 cultures obtained during the study period, 252 (20.2%) were MSSA and 270 (21.6%) were MRSA. The rates of MRSA infections over time increased from 13.5% to 25.7% during 2005-2008. The rates of MRSA in males and females were comparable at 23.3% and 19.6%, respectively. In 2008, MRSA was 97-100% susceptible to vancomycin, linezolid, rifampin, nitrofurantoin, chloramphenicol, gentamycin, tetracycline, and trimethoprim-sulfamethoxazole (TMP-SMZ). To a lesser extent it was susceptible to clindamycin (75%), erythromycin (62%), and levofloxacin (50%).
  
  
  CONCLUSIONS
  There has been a significant increase in the rates of MRSA SSTIs in a suburban ED, yet only 1 in 4 SSTIs are caused by MRSA. Both MRSA and MSSA are completely susceptible to vancomycin, linezolid, rifampin, nitrofurantoin, and chloramphenicol. Gentamicin, tetracycline, and TMP-SMZ cover > 97% of both isolates.
authors.affiliation: Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, New York 11794-7400, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wackett
authors.forename: Andrei
authors.initials: A
authors.lastname: Nazdryn
authors.forename: Eric
authors.initials: E
authors.lastname: Spitzer
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000382:microbiology*; D013207:Staphylococcal Skin Infections / Q000382:microbiology*; D019036:Suburban Health Services / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D008712:Methicillin