1. Community Acquired Methicillin Resistant Staphylococcus aureus in Skin and Soft Tissue Infections
Cheryl Meddles-Torres, DNP, RN, FNP-C
Shuang Hu
Corrine Jurgens, PhD, RN, ANP-BC, FAHA

2. Back ground MRSA- the “superbug” Hospital vs. Community Acquired
HA-MRSA: endemic in health care institutions
CA-MRSA: emerging in persons without the same risk factors associated with MRSA

3. There is an increase in the prevalence of CA-MRSA
Emerged in persons who did not have the same risk factors associated with MRSA in the past:
History of healthcare exposure
Hospitalization
Surgery
Indwelling devices
Hemodialysis
Risk Factors for CA-MRSA
Sports exposure
Incarceration
Intravenous drug use
Overcrowded housing
Poor Hygiene

4. Clinical presentation- Skin and Soft Tissue Infections (SSTIs)
Boils
Abscesses
Cellulitis
Early lesions- “spider bites” or pimples
Common Treatment: Incision and Drainage of SSTIs and antibiotics for Methicillin Sensitive
S. aureus (MSSA) in conjunction with procedure

5. Purpose
Patients are being treated with antibiotics that are useless against CA-MRSA
Increasing the duration of treatment
Increasing the cost associated with treatment
Drugs
Time away from work
Time spent in the Primary Care office

7. Method: Information Technology and Public Health
Center for Disease Control (CDC)
Public use data:
National Ambulatory Medical Care Survey (NAMCS)
Probability sample survey of office based physicians in the US
National Hospital Ambulatory Medical Care Survey (NHAMCS)
Probability sample survey of hospital outpatient departments and emergency departments in the US
Patients presenting for ambulatory medical care were identified from and

8. ICD-9-CM codes that were representative of SSTIs
Prescribing patters of antibiotics grouped into classes
MSSA
Penicillins
Cephalosporins
MRSA
Fluoroquinolones
Tetracyclines
Trimethoprim/ sulfamethoxazole
Unspecified/misc.
Cellulitis/abscess
Skin/subcutaneous infection
Folliculitis
Carbuncle and furuncle
Unspecified local infection of the skin and subcutaneous tissue

9. Statistical Analysis
SAS program to extrapolate data from the NAMCS and NHAMCS databases and compare data from to the data collected from Regression analysis to infer causal relationships between the increase of CA-MRSA in the form of SSTIs and the increase in the prescribing practices of drugs that are useful against CA-MRSA

10. Results Incidence of SSTI increased by 84.7%
Most significant increase was cellulitis/abscess 98.3%
There was no significant differences in patient demographics
Sex, age, ethnicity, race or payment type
Prescription of MSSA antibiotics decreased
Penicillins %
Cephalosporins 24%
Prescription of MRSA antibiotics increased
Tetracyclines 471%
Quinolones/derivatives 94%
Sulfonamides and trimethoprim %

12. Antibiotics for
MRSA

13. Implications There is an increase of SSTI
Prescribing practices have changed in response to the increase of SSTI
Practitioners are taking into account the increase of CA-MRSA in ambulatory care, and are giving appropriate treatment
Future research
Examine susceptibility patterns of CA-MRSA in patients presenting with SSTIs in Primary Care

14. Contact information
Dr. Cheryl Meddles-Torres
Queensborough Community College
Stony Brook University