title: Treatment failure and costs in patients with methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections: a South Texas Ambulatory Research Network (STARNet) study.
abstract: OBJECTIVE
  To measure the incidence of treatment failure and associated costs in patients with methicillin-resistant Staphylococcus aureus skin and soft tissue infections (SSTIs).
  
  
  METHODS
  This was a prospective, observational study in 13 primary care clinics. Primary care providers collected clinical data, wound swabs, and 90-day follow-up information. Patients were considered to have "moderate or complicated" SSTIs if they had a lesion ≥5 cm in diameter or diabetes mellitus. Treatment failure was evaluated within 90 days of the initial visit. Cost estimates were obtained from federal sources.
  
  
  RESULTS
  Overall, treatment failure occurred in 21% of patients (21 of 98) at a mean additional cost of $1,933.71 per patient. In a subgroup analysis of patients who received incision and drainage, those with moderate or complicated SSTIs had higher rates of treatment failure than those with mild or uncomplicated SSTIs (36% vs. 10%; P=.04).
  
  
  CONCLUSIONS
  One in 5 patients presenting to a primary care clinic for a methicillin-resistant S. aureus SSTI will likely require additional interventions at an associated cost of almost $2,000 per patient. Baseline risk stratification and new treatment approaches are needed to reduce treatment failures and costs in the primary care setting.
authors.affiliation: Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Labreche
authors.forename: Grace C
authors.initials: GC
authors.lastname: Lee
authors.forename: Russell T
authors.initials: RT
authors.lastname: Attridge
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.forename: Jim
authors.initials: J
authors.lastname: Koeller
authors.forename: Liem C
authors.initials: LC
authors.lastname: Du
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Nyren
authors.forename: Lucina B
authors.initials: LB
authors.lastname: Treviño
authors.forename: Sylvia B
authors.initials: SB
authors.lastname: Treviño
authors.forename: Joel
authors.initials: J
authors.lastname: Peña
authors.forename: Michael W
authors.initials: MW
authors.lastname: Mann
authors.forename: Abilio
authors.initials: A
authors.lastname: Muñoz
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Marcos
authors.forename: Guillermo
authors.initials: G
authors.lastname: Rocha
authors.forename: Stella
authors.initials: S
authors.lastname: Koretsky
authors.forename: Sandra
authors.initials: S
authors.lastname: Esparza
authors.forename: Mitchell
authors.initials: M
authors.lastname: Finnie
authors.forename: Steven D
authors.initials: SD
authors.lastname: Dallas
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Frei
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D015992:Body Mass Index; D017714:Community-Acquired Infections / Q000191:economics / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology; D004322:Drainage; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D011320:Primary Health Care; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000191:economics* / Q000382:microbiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000191:economics* / Q000628:therapy*; D013781:Texas; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Cost of Illness; Epidemiology; Infectious Diseases; Practice-based Research; Primary Health Care