Purulent skin and soft tissue infection: antibiotic selection in the community.

Kahn, Steven Alexander; Venniro, Erika; Beers, Ryan J; Lentz, Christopher W · J Prim Care Community Health · 2010

retrospective_cohort · Level III

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Abstract

INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) requently causes skin and soft tissue infections (SSTIs). Referring primary care physicians often prescribe inactive antibiotics when referring SSTIs caused by MRSA for incision and debridement. METHODS: Demographics and culture results (organism and sensitivity) were collected for patients treated for SSTI between 2007-2009. Antibiotic regimens started by referring PCPs were noted. Prevalence of MRSA and antibiotic resistance profiles were tabulated. Isolates resistant to the drug initially prescribed were also noted. RESULTS: Of 187 patients, 40.1% grew MRSA. All MRSA was sensitive to doxycycline and trimethoprim-sulfamethoxazole, whereas 88% were sensitive to clindamycin and 79% to levofloxacin. 48% of patients received an antibiotic inadequate for their isolate before referral. CONCLUSIONS: CA-MRSA is extremely common. Patients are often prescribed antibiotics inadequate for MRSA. Doxycycline or trimethoprim-sulfamethoxazole with incision/drainage should be used as initial therapy for SSTI when MRSA is suspected.