THE BENEFIT OF EMPIRIC TREATMENT FOR METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a major pathogen causing skin and soft tissue infections (SSTI). It is unclear whether treatment with antibiotics active in vitro against CA-MRSA improves patient outcomes. At our institution, where there is a high rate of CA-MRSA SSTI, we have adopted an empiric treatment algorithm that promotes both the use of antibiotics likely active against CA-MRSA and early incision and drainage of abscesses. The objective of this research was to study the effectiveness of an empiric treatment algorithm for SSTI directed against CA-MRSA. The study was a retrospective chart review. Treatment was categorized as either conforming or not conforming to the algorithm. Outcomes were categorized as worsening of infection or improvement, according to pre-defined criteria. There were 50 consecutive Emergency Department patients treated as outpatients for MRSA SSTI. Treatment conformed to the algorithm in 29 of 50 cases. Clinical failure occurred in 3% of cases treated according to the algorithm, compared with 62% of those not treated according to the algorithm (p < 0.001). Among 37 cases that underwent immediate incision and drainage, initial treatment with antibiotics active in vitro against the MRSA isolate was associated with a decreased clinical failure rate when compared to those treated with inactive antibiotics (0% vs. 67%, p < 0.001). Empiric treatment of CA-MRSA SSTI according to an algorithm that promotes use of antibiotics active in vitro against CA-MRSA is associated with improved clinical outcomes. (C) 2010 Elsevier Inc.