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

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

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

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

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

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 1997-2002 and 2003-2008

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

Statistical Analysis SAS program to extrapolate data from the NAMCS and NHAMCS databases and compare data from 1997-2002 to the data collected from 2003-2008 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

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 21.2% Cephalosporins 24% Prescription of MRSA antibiotics increased Tetracyclines 471% Quinolones/derivatives 94% Sulfonamides and trimethoprim 4396%

Antibiotics for MRSA

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

Contact information Dr. Cheryl Meddles-Torres Queensborough Community College Cmeddlestorres@qcc.cuny.edu Stony Brook University Cheryl_Meddles-Torres@notes2.nursing.sunysb.edu