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Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus.
Ann Emerg Med. 2008 Mar; 51(3):291-8.AE

Abstract

STUDY OBJECTIVE

Test the hypotheses that emergency department (ED) visits for skin and soft tissue infections became more frequent during the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), and that antibiotics typically active against community-associated MRSA were chosen increasingly.

METHODS

From merged National Hospital Ambulatory Medical Care Survey data for 1993-2005, we identified ED visits with diagnosis of cellulitis, abscess, felon, impetigo, hidradenitis, folliculitis, infective mastitis, nonpurulent mastitis, breast abscess, or carbuncle and furuncle. Main outcomes were change over time in rate of ED visits with such a diagnosis and proportion of antibiotic regimens including an agent typically active against community-associated MRSA. We report national estimates derived from sample weights. We tested trends with least squares linear regression.

RESULTS

In 1993, infections of interest were diagnosed at 1.2 million visits (95% confidence interval [CI] 0.96 to 1.5 million) versus 3.4 million in 2005 (95% CI 2.8 to 4.1 million; P for trend <.001). As a proportion of all ED visits, such infections were diagnosed at 1.35% in 1993 (95% CI 1.07% to 1.64%) versus 2.98% in 2005 (95% CI 2.40% to 3.56%; P for trend <.001). When antibiotics were prescribed at such visits, an antibiotic typically active against community-associated MRSA was chosen rarely from 1993 to 2001 but increasingly thereafter, reaching 38% in 2005 (95% CI 30% to 45%; P for trend <.001). In 2005, trimethoprim-sulfamethoxazole was used in 51% of regimens active against community-associated MRSA.

CONCLUSION

US ED visits for skin and soft tissue infections increased markedly from 1993 to 2005, contemporaneously with the emergence of community-associated MRSA. ED clinicians prescribed more antibiotics typically active against community-associated MRSA, especially trimethoprim-sulfamethoxazole. Possible confounders are discussed, such as increasing diabetes or shifts in locus of care.

Authors+Show Affiliations

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA. dpallin@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18222564

Citation

Pallin, Daniel J., et al. "Increased US Emergency Department Visits for Skin and Soft Tissue Infections, and Changes in Antibiotic Choices, During the Emergence of Community-associated Methicillin-resistant Staphylococcus Aureus." Annals of Emergency Medicine, vol. 51, no. 3, 2008, pp. 291-8.
Pallin DJ, Egan DJ, Pelletier AJ, et al. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med. 2008;51(3):291-8.
Pallin, D. J., Egan, D. J., Pelletier, A. J., Espinola, J. A., Hooper, D. C., & Camargo, C. A. (2008). Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Annals of Emergency Medicine, 51(3), 291-8. https://doi.org/10.1016/j.annemergmed.2007.12.004
Pallin DJ, et al. Increased US Emergency Department Visits for Skin and Soft Tissue Infections, and Changes in Antibiotic Choices, During the Emergence of Community-associated Methicillin-resistant Staphylococcus Aureus. Ann Emerg Med. 2008;51(3):291-8. PubMed PMID: 18222564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. AU - Pallin,Daniel J, AU - Egan,Daniel J, AU - Pelletier,Andrea J, AU - Espinola,Janice A, AU - Hooper,David C, AU - Camargo,Carlos A,Jr Y1 - 2008/01/28/ PY - 2007/07/11/received PY - 2007/11/23/revised PY - 2007/12/03/accepted PY - 2008/1/29/pubmed PY - 2008/3/28/medline PY - 2008/1/29/entrez SP - 291 EP - 8 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 51 IS - 3 N2 - STUDY OBJECTIVE: Test the hypotheses that emergency department (ED) visits for skin and soft tissue infections became more frequent during the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), and that antibiotics typically active against community-associated MRSA were chosen increasingly. METHODS: From merged National Hospital Ambulatory Medical Care Survey data for 1993-2005, we identified ED visits with diagnosis of cellulitis, abscess, felon, impetigo, hidradenitis, folliculitis, infective mastitis, nonpurulent mastitis, breast abscess, or carbuncle and furuncle. Main outcomes were change over time in rate of ED visits with such a diagnosis and proportion of antibiotic regimens including an agent typically active against community-associated MRSA. We report national estimates derived from sample weights. We tested trends with least squares linear regression. RESULTS: In 1993, infections of interest were diagnosed at 1.2 million visits (95% confidence interval [CI] 0.96 to 1.5 million) versus 3.4 million in 2005 (95% CI 2.8 to 4.1 million; P for trend <.001). As a proportion of all ED visits, such infections were diagnosed at 1.35% in 1993 (95% CI 1.07% to 1.64%) versus 2.98% in 2005 (95% CI 2.40% to 3.56%; P for trend <.001). When antibiotics were prescribed at such visits, an antibiotic typically active against community-associated MRSA was chosen rarely from 1993 to 2001 but increasingly thereafter, reaching 38% in 2005 (95% CI 30% to 45%; P for trend <.001). In 2005, trimethoprim-sulfamethoxazole was used in 51% of regimens active against community-associated MRSA. CONCLUSION: US ED visits for skin and soft tissue infections increased markedly from 1993 to 2005, contemporaneously with the emergence of community-associated MRSA. ED clinicians prescribed more antibiotics typically active against community-associated MRSA, especially trimethoprim-sulfamethoxazole. Possible confounders are discussed, such as increasing diabetes or shifts in locus of care. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/18222564/Increased_US_emergency_department_visits_for_skin_and_soft_tissue_infections_and_changes_in_antibiotic_choices_during_the_emergence_of_community_associated_methicillin_resistant_Staphylococcus_aureus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(07)01855-0 DB - PRIME DP - Unbound Medicine ER -