Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T06:04:03.598Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

Published online by Cambridge University Press:  04 March 2015

Bjug Borgundvaag ,
Wil Ng ,
Brian Rowe ,
Kevin Katz  and
on the behalf of EMERGency Department Emerging Infectious Disease Surveillance NeTwork (EMERGENT) Working Group
Bjug Borgundvaag*
Affiliation:
Department of Family and Community Medicine, University of Toronto, Mount Sinai Hospital Schwartz/Reisman Emergency Centre, Toronto, ON Faculty of Medicine, University of Toronto, Toronto, ON
Wil Ng
Affiliation:
Infection Prevention and Control, North York General Hospital, Toronto, ON
Brian Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB
Kevin Katz
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, ON Infection Prevention and Control, North York General Hospital, Toronto, ON
on the behalf of EMERGency Department Emerging Infectious Disease Surveillance NeTwork (EMERGENT) Working Group
Affiliation:
Department of Emergency Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB
*
Mount Sinai Hospital, 600 University Avenue, Room 206, Toronto, ON M5G 1X5; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs.

Methods:

Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grew S. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes.

Results:

Of the 1,353 S. aureus–positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptible S. aureus. We observed significant variation in both the prevalence of MRSA (11–100%) and the proportion of community-associated strains of MRSA (0– 100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada.

Interpretation:

MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.

Keywords

community-associated methicillin-resistant Staphylococcus aureusmethicillin-resistant Staphylococcus aureussoft tissue infectionStaphylococcus aureus
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 3 , May 2013 , pp. 141 - 160
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.Kock, R, Becker, K, Cookson, B, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 2010;15:19688.Google Scholar
2.Simor, AE, Gilbert, NL, Gravel, D, et al. Methicillin-resistant Staphylococcus aureus colonization or infection in Canada: National Surveillance and Changing Epidemiology, 1995–2007. Infect Control Hosp Epidemiol 2010;31:348–56, doi:10.1086/651313.CrossRefGoogle ScholarPubMed
3.Simor, AE, Ofner-Agostini, M, Bryce, E, et al. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001;165:21–6.Google Scholar
4.Simor, AE, Ofner-Agostini, M, Gravel, D, et al. Surveillance for methicillin-resistant Staphylococcus aureus in Canadian hospitals - a report update from the Canadian Nosocomial Infection Surveillance Program. Can Commun Dis Rep 2005;31:33–9.Google Scholar
5.Grundmann, H, Aires-de-Sousa, M, Boyce, J, et al. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public-health threat. Lancet 2006;368:874–85, doi:10.1016/S0140-6736(06)68853-3.Google Scholar
6.Cosgrove, SE, Qi, Y, Kaye, KS, et al. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–74, doi:10.1086/502522.Google Scholar
7.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:2811–5, doi:10.1086/345955.Google Scholar
8.Barton, M, Hawkes, M, Moore, D, et al. Guidelines for the prevention and management of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA): a perspective for Canadian health care practitioners. Can J Infect Dis Med Microbiol 2006;17(Suppl C):4C-24C.CrossRefGoogle Scholar
9.Labandeira-Rey, M, Couzon, F, Boisset, S, et al. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science 2007;315:1130–3, doi:10.1126/science.1137165.CrossRefGoogle ScholarPubMed
10.Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of community- and health care-associated methicillinresistant Staphylococcus aureus infection. JAMA 2003;290:2976–84, doi:10.1001/jama.290.22.2976.Google Scholar
11.Popovich, K, Hota, B, Rice, T, et al. Phenotypic prediction rule for community-associated methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2007;45:2293–5, doi:10.1128/JCM.00044-07.Google Scholar
12.Gilbert, M, MacDonald, J, Gregson, D, et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006;175:149–54, doi:10.1503/cmaj.051565.CrossRefGoogle ScholarPubMed
13.Groom, AV, Wolsey, DH, Naimi, TS, et al. Communityacquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:1201–5, doi:10.1001/jama.286.10.1201.Google Scholar
14.Kaplan, S, Hulten, K, Gonzalez, B, et al. Three-year surveillance of community-acquired Staphylococus aureus infections in children. Clin Infect Dis 2005;40:1785–91, doi:10.1086/430312.Google Scholar
15.Kazakova, SV, Hageman, JC, Matava, M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005;352:468–75, doi:10.1056/NEJMoa042859.CrossRefGoogle ScholarPubMed
16.Lee, NE, Taylor, MM, Bancroft, E, et al. Risk factors for community-associated methicillin-resistant Staphylococcus aureus skin infections among HIV-positive men who have sex with men. Clin Infect Dis 2005;40:1529–34, doi:10.1086/429827.CrossRefGoogle ScholarPubMed
17.Main, C, Jayarante, P, Haley, A, et al. Outbreaks of infection caused by community-acquired methicillin-resistant Staphylococcus aureus in a Canadian correctional facility. Can J Infect Dis Med Microbiol 2005;16:343–8.Google Scholar
18.Mathews, W, Caperna, J, Barber, R, et al. Incidence of and risk factors for clinically significant methicillin-resistant Staphylococcus aureus infection in a cohort of HIV-infected adults. J Acquir Immune Defic Syndr 2005;40:155–60, doi:10.1097/01.qai.0000179464.40948.b9.Google Scholar
19.Rosenthal, A, White, D, Churilla, S, et al. Optimal surveillance culture sites for detection of methicillin-resistant Staphylococcus aureus in newborns. J Clin Microbiol 2006;44:4234–6, doi:10.1128/JCM.00860-06.Google Scholar
20.Zinderman, CE, Conner, B, Malakooti, MA, et al. Community-acquired methicillin-resistant Staphylococcus aureus among military recruits. Emerg Infect Dis 2004;10:941–4, doi:10.3201/eid1005.030604.Google Scholar
21.Tenover, FC, Goering, RV. Methicillin-resistant Staphylococcus aureus strain USA300: origin and epidemiology. J Antimicrob Chemother 2009;64:441–6, doi:10.1093/jac/dkp241.Google Scholar
22.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillinresistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–74, doi:10.1056/NEJMoa055356.Google Scholar
23.Ruhe, J, Smith, N, Menon, A, editors. Significance of antibiotic therapy for the treatment of community-onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections. Interscience Conference on Antimicrobial Agents and Chemotherapy; 2006; San Francisco (CA). American Society for Microbiology.Google Scholar
24.Weibe, KB. Methicillin-resistant S. aureus associated skin and soft tissue infections in a non-urban Canadian emergency department. CJEM 2007;9:198.Google Scholar
25.Adam, HJ, Allen, VG, Currie, A, et al. Comminuty-associated methicillin-resistant Staphylococcus aureus: prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors. CJEM 2009;11:439–46.Google Scholar
26.Stenstrom, R, Grafstein, E, Romney, M, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department. CJEM 2009;11:430–8.Google Scholar
27.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Seventeenth informational supplement. M100-S17. Wayne (PA): Clinical Laboratory Standards Institute; 2007.Google Scholar
28.National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. M7-A7. National Committee for Clinical Laboratory Standards Wayne, PA. 2006.Google Scholar
29.Eltringham, I. Mupirocin resistance and methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1997;35:1–8, doi:10.1016/S0195-6701(97)90162-6.Google Scholar
30.Toma, E, Barriault, D. Antimicrobial activity of fusidic acid and disk diffusion susceptibility testing criteria for grampositive cocci. J Clin Microbiol 1995;33:1712–5.Google Scholar
31.Mulvey, MR, Chui, L, Ismail, J, et al. Development of a Canadian standardized protocol for subtyping methicillinresistant Staphylococcus aureus using pulsed-field gel electrophoresis. J Clin Microbiol 2001;39:3481–5, doi:10.1128/JCM.39.10.3481-3485.2001.Google Scholar
32.Oliveira, DC, de Lencastre, H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2002;46:2155–61, doi:10.1128/AAC.46.7.2155-2161.2002.CrossRefGoogle ScholarPubMed
33.Willey, B, Wong, H, Louie, L, et al, editors. Comparison of two strategies for staphylococcal cassette chromosome mec (SCCmec) typing in methicillin-resistant Staphylococcus aureus. 46th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2006 Sept 27–30; San Francisco, CA.Google Scholar
34.Miller, LG, Perdreau-Remington, F, Bayer, AS, et al. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis 2007;44:471–82, doi:10.1086/511033.Google Scholar
35.Rajendran, PM, Young, D, Maurer, T, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:4044–8, doi:10.1128/AAC.00377-07.CrossRefGoogle Scholar
36.Weese, J, Rousseau, J, Willey, B, et al. Methicillin-resistant Staphylococcus aureus in horses at a veterinary teaching hospital: frequency, characterization, and association with clinical disease. J Vet Intern Med 2006;20:182–6.Google Scholar
37.Kurbis, C, Wylie, J. Community-based cluster of methicillinresistant Staphylococcus aureus in Manitoba. Can J Infect Dis Med Microbiol 2001;12:149–52.Google Scholar
38.Public Health Agency of Canada. Results of surveillance of methicillin-resistant Staphylococcus aureus from 1995 to 2009. Ottawa (ON): Canadian Nosocomial Infection Surveillance Program (CNISP); 2011.Google Scholar
39.McGeer, A, Fleming, C, Green, K, et al. Antimicrobial resistance in common hospital pathogens in Ontario. QMPLS News 2006;104:1–10.Google Scholar
40.Canadian Nosocomial Infection Surveillance Program. Surveillance for methicillin-resistant Staphylococcus aureus in Canadian hospitals - a report update from the Canadian Nosocomial Infection Surveillance Program. Can Commun Dis Rep 2005;31:33–40.Google Scholar
41.Schmitz, GR, Bruner, D, Pitotti, R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for communityassociated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med 2010;56:283–7, doi:10.1016/j.annemergmed.2010.03.002.Google Scholar
42.Frazee, BW, Lynn, J, Charlebois, ED, et al. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 2005;45:311–20, doi:10.1016/j.annemergmed.2004.10.011.Google Scholar
43.Lee, MC, Rios, AM, Aten, MF, et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2004;23:123–7, doi:10.1097/01.inf.0000109288.06912.21.Google Scholar