Trends in prescribing beta-lactam antibiotics for treatment of community-associated methicillin-resistant Staphylococcus aureus infections

Abstract

Rates of prescribing of beta-lactam antibiotics as initial empirical therapy for patients with skin and soft tissue infections (SSTIs) caused by molecularly and epidemiologically characterized community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates were assessed over a 3-year period. A prospectively developed database was used to calculate the prevalence of CA-MRSA SSTIs from 2004 to 2006. Molecular characterization of the MRSA isolate and medical record review for assessment of initial antimicrobial therapy were performed on a subset of patients. Among 2,636 patients with S. aureus SSTIs, the prevalence of CA-MRSA was 9% in 2004, 16% in 2005, and 21% in 2006 (P < 0.0001, chi-square test for trend). Seventy-five percent of CA-MRSA isolates tested were of the USA 300 or 400 clone type. Ninety-two percent of CA-MRSA isolates tested were positive for Panton-Valentine leukocidin, of which 90% carried staphylococcal chromosomal cassette mec type IV. The rate of use of a beta-lactam antibiotic as initial empirical therapy for patients with CA-MRSA SSTIs was 86%, 77%, and 60% in 2004, 2005, and 2006, respectively (P = 0.04, chi-square test for trend). Thirty percent of beta-lactam-treated patients had a documented risk factor for CA-MRSA infection. The use of a beta-lactam antibiotic as initial empirical therapy for CA-MRSA SSTIs has decreased significantly over the past 3 years. However, even as the prevalence of CA-MRSA SSTIs approaches 25%, the majority of patients are still receiving inactive antimicrobial therapy. Further evaluation of the outcomes associated with discordant therapy for CA-MRSA SSTIs is needed.

FIG. 1.

Flow diagram of chart-confirmed CA-MRSA SSTI study population from 2,461 unique MRSA patients.

FIG. 2.

The proportion of patients with a CA-MRSA SSTI being prescribed a β-lactam (solid line) decreased from 2004 to 2006 (P = 0.04, chi-square test for trend) as the prevalence of CA-MRSA SSTIs (dashed line) increased over the same time period (P < 0.0001, chi-square test for trend).