title: Management and outcome of adults with skin and soft tissue infection caused by methicillin-resistant Staphylococcus aureus in a tertiary hospital in central Taiwan.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) has been increasingly causing skin and soft tissue infections (SSTIs). Only limited studies have made comparisons between incision and drainage (I&D) alone and I&D with adjunctive antibiotic therapy for treatment effects, and most of the studies were conducted before the emergence of MRSA. This study was to evaluate whether antibiotics provide added benefit to I&D alone for purulent MRSA SSTIs.
  
  
  METHODS
  This retrospective study collected data on SSTI patients, including patient demographics, treatment strategies, antibiotic susceptibilities of the infecting MRSA isolates, and clinical outcomes over the course of 24 months.
  
  
  RESULTS
  Antimicrobial drug susceptibility rate were 100% for vancomycin, teicoplanin, and linezolid. Among the 211 patients, 7.6% were treated solely with I&D (Group A), 62.6% were treated via I&D with adjunctive antibiotic (Group B), and 29.8% patients received only antibiotics (Group C). The cure rate was highest in Group A (93.8%), followed by Group B (90.9%) and Group C (77.8%). Combining Group B and Group C, patients who were treated appropriately demonstrated a higher cute rate (91.3% vs. 75.4%, p = 0.005). Multivariate analysis showed that Group B was more likely to be successfully treated compared to Group C (odds ratio = 2.51, 95% confidence interval = 1.01-6.25, p = 0.047), whereas no difference between Group A and Group B was found (odds ratio = 2.09, 95% confidence interval = 0.20-22.34, p = 0.542, data not shown).
  
  
  CONCLUSIONS
  Surgical intervention is the definitive therapy for purulent SSTIs. Adjunctive antibiotic therapy increased the cure rate and appropriateness of prescription is influential.
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Soon-Hian
authors.initials: SH
authors.lastname: Teh
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Chi
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lin
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Mao
authors.initials: CM
authors.lastname: Ho
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Chou
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Ta
authors.initials: CT
authors.lastname: Tsai
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Jen-Hsien
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: D7905@mail.cmuh.org.tw.
authors.forename: Mao-Wang
authors.initials: MW
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D013624:Taiwan; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: adjunctive antibiotic therapy; antibiotics susceptibility; incision and drainage; methicillin-resistant Staphylococcus aureus; purulent skin and soft tissue infections