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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: A treatment algorithm for community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) skin infections was revised in 2007 after changes in epidemiology from the original 2004 protocol were documented. The main changes were an emphasis in the need for incision and drainage (I&D) of lesions and to properly treat recurrences.
Objective: Retrospectively review of patients with CA-MRSA skin infections presenting to the emergency department (ED) in the 18 months after treatment algorithm revision.
Methods: All patients with first episode of CA-MRSA skin infections presenting to the ED from November 2007 to April 2009 were reviewed. Patients who did not meet the CDC criteria of CA-MRSA were excluded. Data collected included demographics, chief complaint, culture results, antibiotic therapy, nasal swab result for admitted patients and outcomes.
Results: Electronic records for 74 patients (4 women) were reviewed. Average age was 54 years. All patients had a culture done and 45 patients (61%) had I&D performed during the initial ED visit. Only 9 patients received a beta-lactam on the first visit to the ED (12%) compared to almost 30% before algorithm revision. Eight patients were changed to anti-MRSA agents after cultures results were available; one patient, who received I&D, responded to beta-lactam therapy. Fourteen patients needed hospital admission (19%) and 12 of 13 (92%) with nasal swabs had a positive MRSA screen upon admission. Nineteen patients had at least one recurrent episode (27%) a median of 2 months after the initial one, compared to 39% a median of 3 months for the patients evaluated prior to the algorithm revision. Eighteen of these 19 patients (95%) received appropriate treatment upon recurrence.
Objective: Retrospectively review of patients with CA-MRSA skin infections presenting to the emergency department (ED) in the 18 months after treatment algorithm revision.
Methods: All patients with first episode of CA-MRSA skin infections presenting to the ED from November 2007 to April 2009 were reviewed. Patients who did not meet the CDC criteria of CA-MRSA were excluded. Data collected included demographics, chief complaint, culture results, antibiotic therapy, nasal swab result for admitted patients and outcomes.
Results: Electronic records for 74 patients (4 women) were reviewed. Average age was 54 years. All patients had a culture done and 45 patients (61%) had I&D performed during the initial ED visit. Only 9 patients received a beta-lactam on the first visit to the ED (12%) compared to almost 30% before algorithm revision. Eight patients were changed to anti-MRSA agents after cultures results were available; one patient, who received I&D, responded to beta-lactam therapy. Fourteen patients needed hospital admission (19%) and 12 of 13 (92%) with nasal swabs had a positive MRSA screen upon admission. Nineteen patients had at least one recurrent episode (27%) a median of 2 months after the initial one, compared to 39% a median of 3 months for the patients evaluated prior to the algorithm revision. Eighteen of these 19 patients (95%) received appropriate treatment upon recurrence.
Conclusions: A revised treatment algorithm for CA-MRSA skin infections continues to facilitate timely and proper treatment of patients with CA-MRSA, including recurrences, at our medical center.