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Abstract #147000

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J. Rush Pierce Jr., MD, MPH¹, Alicia E.I. Pittard, BA¹, Anne V. Denison, RN, BSN, MS¹, Susan K. Strickland, RN, BSN², Amanda Arellano², Matthew Whinery, BS², and J. Matthew Richardson, MPH². (1) Department of Internal Medicine, Texas Tech University Health Sciences Center, 1400 S. Coulter, Amarillo, TX 79106, 806.354.5401, rush.pierce@ttuhsc.edu, (2) Department of Public Health, City of Amarillo, P.O. Box 1971, Amarillo, TX 79105-1971

Background. MRSA infections have traditionally occurred in hospitalized patients or those receiving medical interventions. Recently MRSA infections have occurred in persons without these hospital-associated risk factors. This study examines these CA-MRSA infections in a two county area with a population of 200,000.

Methods. We reviewed all MRSA cultures from Amarillo hospital laboratories obtained in 2004. We then reviewed medical records to exclude patients with hospital-associated risk factors. Remaining patients were interviewed to further exclude hospital-associated cases, and to ascertain clinical features of their disease.

Results. Of approximately 1100 MRSA cases in 2004, 289 had probable CA-MRSA infection. Of the 142 cases which were interviewed, 132 had confirmed CA-MRSA. Among CA-MRSA cases children and Hispanics were underrepresented (19% of cases were children vs. 29% of the population; 12% of cases were Hispanic vs. 22% of the population). At least 42% of confirmed CA-MRSA infections took longer than 4 weeks to resolve and 7% were recurrent. Almost all patients (96%) with confirmed CA-MRSA had skin or soft tissue infections. Of these, 41% were mistaken for a spider bite by the patient and/or the physician. Over 95% of the CA-MRSA infections were sensitive to rifampin, tetracycline, and trimethoprim-sulfamethoxazole . Clindamycin resistance was seen in 15% and fluoroquinilone resistance in 50%. A significant proportion (43%) reported exposure to someone with a Staph infection. Most patients (80%) were not familiar with MRSA.

Conclusions. CA-MRSA has become a serious and common illness in our community, and has major public health implications.

Learning Objectives:

• List three ways that CA-MRSA skin and soft tissue infections look differently than usual skin and soft tissue infections with Staph aureus.
• Articulate why CA-MRSA skin and soft tissue infections are frequently mistaken for spider bites.
• Describe three reasons why CA-MRSA is an important public health problem.

Keywords: Emerging Diseases, Infectious Diseases

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

• Slides (pdf) or Handout
• Multimedia recording