Pallin DJ, Egan DJ, Pelletier AJ, Espinola JA, Hooper DC, Camargo CA Jr, et al.
Annals of emergency medicine. Date of publication 2008 Mar 1;volume 51(3):291-8.
1. Ann Emerg Med. 2008 Mar;51(3):291-8. doi: 10.1016/j.annemergmed.2007.12.004.
Epub 2008 Jan 28.
Increased US emergency department visits for skin and soft tissue infections,
and changes in antibiotic choices, during the emergence of community-associated
methicillin-resistant Staphylococcus aureus.
Pallin DJ(1), Egan DJ, Pelletier AJ, Espinola JA, Hooper DC, Camargo CA Jr.
Author information:
(1)Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA,
USA. dpallin@partners.org
Comment in
Ann Emerg Med. 2008 Mar;51(3):299-302.
STUDY OBJECTIVE: Test the hypotheses that emergency department (ED) visits for
skin and soft tissue infections became more frequent during the emergence of
community-associated methicillin-resistant Staphylococcus aureus (MRSA), and
that antibiotics typically active against community-associated MRSA were chosen
increasingly.
METHODS: From merged National Hospital Ambulatory Medical Care Survey data for
1993-2005, we identified ED visits with diagnosis of cellulitis, abscess, felon,
impetigo, hidradenitis, folliculitis, infective mastitis, nonpurulent mastitis,
breast abscess, or carbuncle and furuncle. Main outcomes were change over time
in rate of ED visits with such a diagnosis and proportion of antibiotic regimens
including an agent typically active against community-associated MRSA. We report
national estimates derived from sample weights. We tested trends with least
squares linear regression.
RESULTS: In 1993, infections of interest were diagnosed at 1.2 million visits
(95% confidence interval [CI] 0.96 to 1.5 million) versus 3.4 million in 2005
(95% CI 2.8 to 4.1 million; P for trend <.001). As a proportion of all ED
visits, such infections were diagnosed at 1.35% in 1993 (95% CI 1.07% to 1.64%)
versus 2.98% in 2005 (95% CI 2.40% to 3.56%; P for trend <.001). When
antibiotics were prescribed at such visits, an antibiotic typically active
against community-associated MRSA was chosen rarely from 1993 to 2001 but
increasingly thereafter, reaching 38% in 2005 (95% CI 30% to 45%; P for trend
<.001). In 2005, trimethoprim-sulfamethoxazole was used in 51% of regimens
active against community-associated MRSA.
CONCLUSION: US ED visits for skin and soft tissue infections increased markedly
from 1993 to 2005, contemporaneously with the emergence of community-associated
MRSA. ED clinicians prescribed more antibiotics typically active against
community-associated MRSA, especially trimethoprim-sulfamethoxazole. Possible
confounders are discussed, such as increasing diabetes or shifts in locus of
care.
DOI: 10.1016/j.annemergmed.2007.12.004
PMID: 18222564 [Indexed for MEDLINE]
