Should the methicillin-resistant Staphylococcus aureus carriage status be used as a guide to treatment for skin and soft tissue infections? - 18/04/12
Corresponding author. Service of Infectious Diseases, Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, 4, Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. Tel.: +41 223723311; fax: +41 223723987.Summary |
Objective |
Previous skin carriage of methicillin-resistant Staphylococcus aureus (MRSA) leads frequently to empiric antibiotic MRSA coverage for skin & soft tissue infections.
Methods |
Retrospective cohort study of orthopaedic patients hospitalized at Geneva University Hospitals (MRSA prevalence; 30%); community-acquired MRSA excluded.
Results |
A total of 378 skin and soft tissue infections in 346 patients were retrieved. Overall cure was achieved in 330 episodes (87%) after a median antibiotic administration of 15 days. Among all episodes, 102 revealed a positive current MRSA status (during 2 weeks preceding infection; 27%) and 70 (19%) were MRSA carriers in the past. Sensitivity, specificity, positive and negative predictive values of current MRSA skin carriage to predict abscesses due to MRSA were 0.68, 0.77, 0.19, and 0.97, respectively. Fifty-four current MRSA carriers (54/102, 53%) and 30 past carriers (43%) were successfully treated with a non-MRSA antibiotic agent. In multivariate Cox regression analysis, anti-MRSA coverage (hazard ratio 1.2, 95%CI 0.5–2.8) and duration of antibiotic therapy (HR 1.0, 95%CI 0.96–1.02) did not influence treatment failure among patients with positive MRSA carriage.
Conclusions |
Current or past HA-MRSA skin carriage poorly predicts the need for anti-MRSA coverage for the antibiotic treatment of skin and soft tissue infections in hospitalized orthopaedic patients.
Le texte complet de cet article est disponible en PDF.Keywords : MRSA, Colonization, Antibiotic, Empirical, Skin & soft tissue infection
Plan
 | The material presented in the paper is not published or submitted elsewhere. The data presented is the work of all authors listed. The authors have no conflict of interest or financial interest in connection with this work and all authors have seen, approved, and contributed to the manuscript. There is no funding of this study. Parts of the topic were presented at the Annual Congress of the Swiss Society for Infectious Diseases in Interlaken, Switzerland, August 2011. |
Vol 64 - N° 5
P. 513-519 - mai 2012 Retour au numéro
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