Introduction: The emergence of methicillin resistant Staphylococcus aureus (MRSA) is a challenge in the management of skin and soft tissue infections (SSTIs).
Objective: To describe the epidemiology of MRSA SSTIs among admitted patients at the University of Santo Tomas Hospital (USTH).
Methods: This was a retrospective study of inpatients with MRSA SSTIs from 2011-2015. MRSA infections were classified as community-associated (CA-MRSA) and healthcare-associated (HA-MRSA). Demographic characteristics, clinical profile, co-morbidities, complications, risk factors, antibiotic susceptibility and resistance, treatment used and clinical outcome were determined.
Results: Out of the 331 inpatients with Staphylococcus aureus SSTIs, 211 had MRSA, with a prevalence of 63.7%. 80.1% of MRSA were CA-MRSA while 19.9% were HA-MRSA. Mean age was 41.58 years with male predominance. Majority presented with abscess (62.9%), on the legs (21.8%). Abscess was significantly associated with CA-MRSA while infected wounds, previous hospitalization and surgery were correlated with HA-MRSA. A growing resistance to ciprofloxacin, tetracycline, macrolides, co-trimoxazole and clindamycin was noted. Low percentage of resistance to vancomycin and linezolid was observed. Almost all cases improved with appropriate antibiotic therapy with 3.3% mortality.
Conclusion: More than half of patients with Staphylococcus aureus SSTIs had MRSA. Mostly were CA-MRSA and males. Abscess on the leg was the common presentation and significantly associated with CA-MRSA. Infected wounds, previous hospitalization and surgery were associated with HA-MRSA. There was a high resistance of MRSA to ciprofloxacin and tetracycline while low resistance to vancomycin and linezolid. Almost all improved with appropriate treatment.
- McCaig LF, McDonald LC, Mandal S, Jernigan DB. Staphylococcus aureus–associated skin and soft tissue infections in ambulatory care. Emerging Infectious Diseases. 2006 Nov;12(11):1715.
- Tattevin P, Schwartz BS, Graber CJ, Volinski J, Bhukhen A, Bhukhen A, et al. Concurrent epidemics of skin and soft tissue infection and bloodstream infection due to community-associated methicillin-resistant Staphylococcus aureus. Clinical Infectious Diseases. 2012 Jun 5;55(6):781-8.
- Tinelli M, Monaco M, Vimercati M, Ceraminiello A, Pantosti A. Methicillin-susceptible Staphylococcus aureus in skin and soft tissue infections, Northern Italy. Emerging Infectious Diseases. 2009 Feb;15(2):250.
- Cuaresma AL, FPCP MM, FPCP F. Socio-demographic Profile and Clinical Presentation of Inpatients with Community Acquired-Methicillin Resistant Staphylococcus aureus (CA-MRSA) Skin and Soft Tissue Infection at the University of Santo Tomas Hospital. Philippine Journal of Microbiology and Infectious Diseases. 2008 Jan;37(1).
- Kho EH, Lim J. A retrospective study of the prevalence and sensitivity pattern of methicillin-resistant staphylococcus aureus in a Chong Hua Hospital, Cebu City, 2007-2010. Pediatric Infectious Disease Society of the Philippines Journal. 2013 Dec 1;14(2):85-93.
- Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Annals of Emergency Medicine. 2005 Mar 1;45(3):311-20.
- Song JH, Hsueh PR, Chung DR, Ko KS, Kang CI, Peck KR, et al. Spread of methicillin-resistant Staphylococcus aureus between the community and the hospitals in Asian countries: an ANSORP study. Journal of Antimicrobial Chemotherapy. 2011 Feb 20;66(5):1061-9.
- Otter JA, French GL. Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus: an emerging threat. The Lancet Infectious Diseases. 2006 Dec 1;6(12):753-5.
- Johnson JK, Khoie T, Shurland S, Kreisel K, Stine OC, Roghmann MC. Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus USA300 clone. Emerging Infectious Diseases. 2007 Aug;13(8):1195.
- Peacock SJ, Paterson GK. Mechanisms of methicillin resistance in Staphylococcus aureus. Annual Review of Biochemistry. 2015 Jun 2;84.
- Ontengco DC, Matias RR, Md CA, Tuazon EO. 1 Methicillin-resistant Staphylococcus aureus isolates from Filipino patients (1999-2003).
- Farley JE. Epidemiology, clinical manifestations, and treatment options for skin and soft tissue infection caused by community‐acquired methicillin‐resistant Staphylococcus aureus. Journal of the American Academy of Nurse Practitioners. 2008 Feb;20(2):85-92.
- Ho PL, Chuang SK, Choi YF, Lee RA, Lit AC, Ng TK, et al. Community-associated methicillin-resistant and methicillin-sensitive Staphylococcus aureus: skin and soft tissue infections in Hong Kong. Diagnostic microbiology and infectious disease. 2008 Jul 1;61(3):245-50.
- Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clinical Infectious Diseases. 2003 Feb 1;36(3):281-5.
- Salgado CD, Farr BM, Calfee DP. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clinical Infectious Diseases. 2003 Jan 15;36(2):131-9.
- Ray GT, Suaya JA, Baxter R. Incidence, microbiology, and patient characteristics of skin and soft-tissue infections in a US population: a retrospective population-based study. BMC Infectious Diseases. 2013 Dec;13(1):252.
- Uy AM, Liza GM, Anna OL. The clinical and epidemiologic profile of community-associated methicillin-resistant Staphylococcus aureus infection among pediatric patients admitted at the Philippine General Hospital. Pediatric Infectious Disease Society of the Philippines Journal. 2011 Jan 1;12(1):2-10.
- Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick’s Dermatology in General Medicine, 2 volumes. Transplantation. 2008;85(654).
- Dryden M, Baguneid M, Eckmann C, Corman S, Stephens J, Solem C, et al. Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections. Clinical Microbiology and Infection. 2015 Sep 1;21:S27-32.
- Tiwari AK, Lal R. Study to evaluate the role of severity stratification of skin and soft tissue infections (SSTIs) in formulating treatment strategies and predicting poor prognostic factors. International Journal of Surgery. 2014 Feb 1;12(2):125-33.
- Skov R, Christiansen K, Dancer SJ, Daum RS, Dryden M, Huang YC, et al. Update on the prevention and control of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). International Journal of Antimicrobial Agents. 2012 Mar 1;39(3):193-200.
- Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clinical Microbiology Reviews. 2015 Jul 1;28(3):603-61.
- Turabelidze G, Lin M, Wolkoff B, Dodson D, Gladbach S, Zhu BP. Personal hygiene and methicillin-resistant Staphylococcus aureus infection. Emerging Infectious Diseases. 2006 Mar;12(3):422.
- Enright MC, Robinson DA, Randle G, Feil EJ, Grundmann H, Spratt BG. The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proceedings of the National Academy of Sciences. 2002 May 28;99(11):7687-92.
- Boyce JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infection Control & Hospital Epidemiology. 1992 Dec;13(12):725-37.
- Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, et al. Comparison of community-and health care–associated methicillin-resistant Staphylococcus aureus infection. Jama. 2003 Dec 10;290(22):2976-84.
- Centers for Disease Control and Prevention (CDC. Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005. MMWR. Morbidity and Mortality Weekly Report. 2007 Mar 9;56(9):197.
- Nguyen DB, Lessa FC, Belflower R, Mu Y, Wise M, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005–2011. Clinical Infectious Diseases. 2013 Aug 19;57(10):1393-400.
- Daum RS. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. New England Journal of Medicine. 2007 Jul 26;357(4):380-90.
- Research Institute for Tropical Medicine. Department of Health, Philippines. Antimicrobial Resistance Surveillance Program: 2015 Data Summary Report. 2015;84.
Articles related to the one you are viewing
There are currently no results to show, please try again later
CC BY: Open Access Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/