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Community-associated methicillin-resistant Staphylococcus aureus: prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors

Published online by Cambridge University Press:  21 May 2015

Heather J. Adam ,
Vanessa G. Allen ,
Andrea Currie ,
Allison J. McGeer ,
Andrew E. Simor ,
Susan E. Richardson ,
Lisa Louie ,
Barbara Willey ,
Tim Rutledge  and
Jacques Lee
...Show all authors
Heather J. Adam
Affiliation:
Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
Vanessa G. Allen
Affiliation:
Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
Andrea Currie
Affiliation:
Departments of Infection Prevention and Control and Emergency Medicine, North York General Hospital, North York, Ont.
Allison J. McGeer
Affiliation:
Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont. Departments of Emergency Medicine and Microbiology, Mount Sinai Hospital, Toronto, Ont.
Andrew E. Simor
Affiliation:
Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont. Departments of Microbiology and Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
Susan E. Richardson
Affiliation:
Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont. Division of Microbiology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ont.
Lisa Louie
Affiliation:
Departments of Microbiology and Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
Barbara Willey
Affiliation:
Departments of Emergency Medicine and Microbiology, Mount Sinai Hospital, Toronto, Ont.
Tim Rutledge
Affiliation:
Departments of Infection Prevention and Control and Emergency Medicine, North York General Hospital, North York, Ont.
Jacques Lee
Affiliation:
Departments of Microbiology and Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
Ran D. Goldman
Affiliation:
Department of Emergency Medicine, Vancouver Children’s Hospital, Vancouver, BC
Andrea Somers
Affiliation:
Department of Emergency Medicine, University Health Network, Toronto, Ont.
Paul Ellis
Affiliation:
Department of Emergency Medicine, University Health Network, Toronto, Ont.
Alicia Sarabia
Affiliation:
Departments of Microbiology and Emergency Medicine, Credit Valley Hospital; Toronto, Ont.
John Rizos
Affiliation:
Departments of Microbiology and Emergency Medicine, Credit Valley Hospital; Toronto, Ont.
Bjug Borgundvaag
Affiliation:
Departments of Emergency Medicine and Microbiology, Mount Sinai Hospital, Toronto, Ont.
Kevin C. Katz*
Affiliation:
Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont. Departments of Infection Prevention and Control and Emergency Medicine, North York General Hospital, North York, Ont. Department of Laboratory Medicine, North York General Hospital; North York, Ont.
*
Department of Laboratory Medicine, North York General Hospital, Toronto ON M2K 1E1; [email protected]

Abstract

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Objective:

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), which is caused primarily by the Canadian methicillin-resistant Staphylococcus aureus-10 (CMRSA-10) strain (also known as the USA300 strain) has emerged rapidly in the United States and is now emerging in Canada. We assessed the prevalence, risk factors, microbiological characteristics and outcomes of CA-MRSA in patients with purulent skin and soft tissue infections (SSTIs) presenting to emergency departments (EDs) in the Greater Toronto Area.

Methods:

Patients with Staphylococcus aureus SSTIs who presented to 7 EDs between Mar. 1 and Jun. 30, 2007, were eligible for inclusion in this study. Antimicrobial susceptibilities and molecular characteristics of MRSA strains were identified. Demographic, risk factor and clinical data were collected through telephone interviews.

Results:

MRSA was isolated from 58 (19%) of 299 eligible patients. CMRSA-10 was identified at 6 of the 7 study sites and accounted for 29 (50%) of all cases of MRSA. Telephone interviews were completed for 161 of the eligible patients. Individuals with CMRSA-10 were younger (median 34 v. 63 yr, p = 0.002), less likely to report recent antibiotic use (22% v. 67%, p = 0.046) or health care–related risk factors (33% v. 72%, p = 0.097) and more likely to report community-related risk factors (56% v. 6%, p = 0.008) than patients with other MRSA strains. CMRSA-10 SSTIs were treated with incision and drainage (1 patient), antibiotic therapy (3 patients) or both (5 patients), and all resolved. CMRSA-10 isolates were susceptible to clindamycin, tetracycline and trimethoprimsulfamethoxazole.

Conclusion:

CA-MRSA is a significant cause of SSTIs in the Greater Toronto Area, and can affect patients without known community-related risk factors. The changing epidemiology of CA-MRSA necessitates further surveillance to inform prevention strategies and empiric treatment guidelines.

Keywords

Staphylococcus aureusmethicillin resistancecommunity-associated infectionsrisk factorsskin diseases and infectionssoft tissue infectionspediatricfever
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 5 , September 2009 , pp. 439 - 446
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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