Prevalence, severity, and treatment of CA-MRSA skin and soft tissue infections in 10 outpatient clinics in Texas

The purpose of this thesis was to 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). Ten clinics participated in this prospective, community-based study. Clinicians consented patients and collected clinical information, pictures, and wound swabs; data were processed centrally. MRSASelect[trademark] was used for identification. Susceptibilities were determined via Etest[registered sign]. The results are as follows. Overall, 73/119 (61%) patients had CA-MRSA. Among these, 49% were male, 79% were Hispanic, and 30% had diabetes. Half (56%) of the lesions were [greater than or equal to] 5 cm in diameter. Most patients had abscesses (82%) and many reported pain scores of [greater than or equal to] 7/10 (67%). Many presented with erythema (85%) or drainage (56%). Most received incision and drainage (I&D) plus an antibiotic (64%). Antibiotic monotherapy was frequently prescribed: sulfamethoxazole/ trimethoprim (SMX/TMP) (78%), clindamycin (4%), doxycycline (2%), and mupirocin (2%). The rest frequently received SMX/TMP in combination with other antibiotics. SMX/TMP was commonly administered as one double-strength tablet twice daily. Isolates were 93% susceptible to clindamycin and 100% susceptible to vancomycin, doxycycline, SMX/TMP, and linezolid. We report a predominance of CA-MRSA SSTIs, favorable susceptibilites, and frequent prescribing of SMX/TMP in primary care clinics located in South Texas.