【CID2011】Comparison of SAFrom SSTI in US emergency department patient

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题目：Comparison of Staphylococcus aureus From Skin and Soft-Tissue Infections in US Emergency Department Patients, 2004 and 2008
David A. Talan,1,2 Anusha Krishnadasan,1 Rachel J. Gorwitz,3 Gregory E. Fosheim,3 Brandi Limbago,3 Valerie Albrecht,3
and Gregory J. Moran1,2 for The EMERGEncy ID Net Study Group
[摘要]
Background. In the past decade, new methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged
as a predominant cause of community-associated skin and soft-tissue infections (SSTIs). Little information exists
regarding trends in MRSA prevalence and molecular characteristics or regarding antimicrobial susceptibility profiles
of S. aureus isolates.
Methods. We enrolled adults with acute, purulent SSTIs presenting to a US network of 12 emergency
departments during August 2008. Cultures and clinical information were collected. S. aureus isolates were
characterized by antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and toxin genes detection. The
prevalence of S. aureus and MRSA and isolate genetic characteristics and susceptibilities were compared with those
from a similar study conducted in August 2004.
Results. The prevalence of MRSA was 59% among all SSTIs during both study periods; however, the prevalence
by site varied less in 2008 (38%–84%), compared with 2004 (15%–74%). Pulsed-field type USA300 continued to
account for almost all MRSA isolates (98%). Susceptibility to trimethoprim-sulfamethoxazole, clindamycin, and
tetracycline among MRSA isolates remained greater than 90% in 2008. A higher proportion of MRSA infections
were treated with an agent to which the infecting isolate was susceptible in vitro in 2008 (97%), compared with 2004
(57%).
Conclusions. Similar to 2004, MRSA remained the most common identifiable cause of purulent SSTIs among
patients presenting to a network of US emergency departments in 2008. The infecting MRSA isolates continued to
be predominantly pulsed-field type USA300 and susceptible to recommended non–b-lactam oral agents. Clinician
prescribing practices have shifted from MRSA-inactive to MRSA-active empirical antimicrobial regimens.