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Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Robert Stenstrom ,
Eric Grafstein ,
Marc Romney ,
John Fahimi ,
Devin Harris ,
Garth Hunte ,
Grant Innes  and
Jim Christenson
Robert Stenstrom*
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC The Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
Eric Grafstein
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC The Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
Marc Romney
Affiliation:
Department of Microbiology, St. Paul's Hospital, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
John Fahimi
Affiliation:
Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
Devin Harris
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC Department of Microbiology, St. Paul's Hospital, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
Garth Hunte
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC The Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
Grant Innes
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC Department of Microbiology, St. Paul's Hospital, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
Jim Christenson
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC Department of Microbiology, St. Paul's Hospital, Vancouver, BC Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
*
Emergency Department, St. Paul's Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6; [email protected]

Abstract

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Objective:

We sought to estimate the period prevalence of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) and evaluate risk factors for MRSA SSTI in an emergency department (ED) population.

Methods:

We carried out a cohort study with a nested case–control design. Patients presenting to our ED with a wound culture and a discharge diagnosis of SSTI between January 2003 and September 2004 were dichotomized as MRSA positive or negative. Fifty patients with MRSA SSTI matched by calendar time to 100 controls with MRSA-negative SSTI had risk factors assessed using multivariate conditional logistic regression.

Results:

Period prevalence of MRSA SSTI was 54.8% (95% confidence interval [CI] 50.2%–59.4%). The monthly period prevalence increased from 21% in January 2003 to 68% in September 2004 (p < 0.01). Risk factors for MRSA SSTI were injection drug use (IDU) (odds ratio [OR] 4.6, 95% CI 1.4–16.1), previous MRSA infection and colonization (OR 6.4, 95% CI 2.1–19.8), antibiotics in 8 weeks preceding index visit (OR 2.6, 95% CI 1.2–8.1), diabetes mellitus (OR 4.1, 95% CI 1.4–12.1), abscess (OR 5.6, 95% CI 1.8–17.1) and admission to hospital in previous 12 months (OR 2.6, 95% CI 1.1–11.2).

Conclusion:

The period prevalence of MRSA SSTI between January 2003 and September 2004 was 54.8% at our institution. There was a marked increase in the monthly period prevalence from the beginning to the end of the study. Risk factors are IDU, previous MRSA infection and colonization, prescriptions for antibiotics in previous 8 weeks and admission to hospital in the preceding 12 months. On the basis of local prevalence and risk factor patterns, emergency physicians should consider MRSA as a causative agent for SSTI.

Keywords

methicillin-resistant Staphylococcus aureus (MRSA)skin and soft tissue infectionprevalenceemergency departmentrisk factorscase–control study
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 5 , September 2009 , pp. 430 - 438
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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