1249. Moderate-Complicated Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections (SSTIs) in 10 Primary Care Clinics: A STARNet Study
Session: Poster Abstract Session: Staphylococcal Resistance and Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Patients admitted to emergency departments and hospitals with SSTIs frequently have moderate-complicated infections; however, the prevalence of such infections in primary care clinics is largely unknown. Clinical practice guidelines endorse incision and drainage (I&D) plus antibiotics for these patients, so under-recognition of these moderate-complicated infections may lead to under-treatment in the primary care setting.     

Methods: Clinicians from 10 primary care clinics in a regional Practice-Based Research Network (PBRN) collected clinical data and skin cultures from 72 patients with MRSA SSTIs. MRSA were confirmed at a central research laboratory via MRSA Select™ agar. Modified U.S. Food and Drug Administration criteria were used to classify SSTIs as moderate-complicated (diabetes mellitus or lesions ≥ 5 cm in diameter) or mild-uncomplicated infections. Contingency table analysis was used to compare patient and treatment characteristics between the two groups.

Results: Half the patients were male (50%) and most were Hispanic (75%). Two-thirds (67%) had moderate-complicated SSTIs. Diabetes was present in 46% of the patients with moderate-complicated SSTIs; 81% had a lesion ≥ 5cm and 27% had both diabetes and a lesion ≥ 5cm. I&D plus antibiotics were used for treatment in 63% of patients with moderate-complicated and 67% with mild-uncomplicated infections (p = 0.7, chi-square); 27% and 29% received antibiotics without I&D (p = 0.9); 8% and 4% received I&D only (p = 0.5); 2% and 0% went for surgery (p = 0.3). Trimethoprim-sulfamethoxazole (TMP-SMX) was prescribed to 95% of the moderate-complicated and 87% of the mild-uncomplicated patients (p = 0.3); 17% and 13% received TMP-SMX in combination with other antibiotics (p = 0.7). 

Conclusion: Moderate-complicated SSTIs are common in the primary care setting. I&D plus antibiotics are underutilized in these patients. 


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Matthew J. Labreche, PharmD1,2, Nicolas A. Forcade, PharmD, MSc1,2, Michael L. Parchman, MD, MPH2,3, Liem C. Du, MD4, Natalie R. Nyren, PA4, Lucina B. Treviņo, MD4, Joel Peņa, MD4, Michael W. Mann, MD4, Abilio Munoz, MD4, Sylvia B. Treviņo, PA4, Brian L. Wickes, PhD2, Eric M. Mortensen, MD, MSc2,3, James H. Jorgensen, PhD2, Brad H. Pollock, MPH, PhD2 and Christopher R. Frei, PharmD, MSc1,2, (1)UT Austin, Austin, TX, (2)UT Health Science Center, San Antonio, TX, (3)VERDICT, South Texas Veterans Health Care System, San Antonio, TX, (4)South Texas Ambulatory Research Network (STARNet), San Antonio, TX

Disclosures:

M. J. Labreche, None

N. A. Forcade, None

M. L. Parchman, None

L. C. Du, None

N. R. Nyren, None

L. B. Treviņo, None

J. Peņa, None

M. W. Mann, None

A. Munoz, None

S. B. Treviņo, None

B. L. Wickes, None

E. M. Mortensen, None

J. H. Jorgensen, bioMeriuex: Investigator, Research grant

B. H. Pollock, None

C. R. Frei, AstraZeneca: Investigator, Research grant
Forest: Scientific Advisor, Consulting fee
OrthoMcNeil Janssen: Consultant, Investigator and Scientific Advisor, Consulting fee and Research grant
Pfizer: Investigator, Research grant
NIH/NCRR: Investigator, Grant recipient and UL1 RR025767

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.