IDSA Emerging Infections Network
IDSA Emerging Infections Network
Report for MRSA Skin and Soft Tissue Infection Query
Overall response rate: 486/1016 (47.8%) physicians responded
358 physicians with adult ID practices
110 physicians with pediatric ID practices
18 physicians responded by indicating they did not see (or did not treat) MRSA SSTI and were unable to answer
Numbers for some questions may add to less than 358 because not all respondents answered all questions.
Adult Survey Responders (N=358):
Of patient-care time, percent spent providing inpatient care:
Mean 63.7% (SD 26.3)
Median 70%
Mode 80%
Range 0 (N=4) to 100% (N=9)
Of patient-care time, percent spent providing outpatient care:
Mean 30.9% (SD 23.3)
Median 25%
Mode 20%
Range 0 (N=7) to 100% (N=2)
Are you seeing more MRSA SSTI in the past 12 months compared with the previous year?
Many fewer cases 0
Somewhat fewer 2 (0.6)
About the same 48 (13.5)
Somewhat more 159 (44.7)
Many more 147 (41.3)
Are you seeing more MRSA SSTI in the past 12 months compared with 2003?
Many fewer cases 0
Somewhat fewer 5 (1.4)
About the same 11 (3.1)
Somewhat more 77 (21.9)
Many more 259 (73.6)
What percentage of your ‘curbside consults’ now involve MRSA SSTI?
Mean 19.4% (SD 16.4), range 0-90%
Are you seeing more MRSA SSTI in the following specific populations?
Yes No N/A
Athletes 148 (41) 130 (36) 80 (23)
Incarcerated persons 145 (40) 100 (28) 113 (32)
People with HIV 193 (54) 146 (41) 19 (5)
Health care workers 182 (51) 151 (42) 25 (7)
Healthy adults 327 (91) 17 (5) 14 (4)
Other groups:
Children 22
Diabetics 16
IV drug users 14
Adolescents/young adults/college students 12
Families 10
Surgical site infections 7
Indigent/low socioeconomic status/homeless patients 7
Elderly/Nursing home or institutionalized patients 5
Amphetamine, crystal meth or cocaine users (not IVDU) 5
Patients with cancer or other immunosuppression 4
Military recruits / active duty military / young veterans 4
Prison guards/policemen/law enforcement 4
[N=3 each) Patients with chronic derm conditions, obese patients, ‘everyone’]
[(N=2 each) Mechanics, smokers, gay males not HIV-infected, dialysis patients]
[(N=1 each) All chronic illnesses, people caring for young children (e.g., housekeepers), people with recent tattoos/piercings, ulcers in leprosy patients, alcoholism, transplant patients, fairly normal adults, in contact with health care system, teachers, recently hospitalized, patients with hepatitis C]
How many cases of MRSA SSTI have you seen during your last month of clinical service?
Mean 10.5 (SD 12.0), range 0 (N=7) to 100 (N=1)
How many of those cases of MRSA SSTI required drainage by a surgeon?
Mean 4.9 (SD 7.1), range 0 (N=33) to 90 (N=1)
Are you seeing more severe cases of MRSA SSTI in the last 12 months?
Many fewer cases 1 (0.3)
Somewhat fewer 5 (1.4)
About the same 131 (37.0)
Somewhat more 164 (46.3)
Many more 53 (15.0)
In patients with MRSA SSTI, what other complications are you most commonly encountering?
Rank order 1: Severe local disease without metastatic foci, by 207 (61.1%)
Rank order 2: Bacteremia, by 101 (40.9%)
Rank order 3: Pneumonia, by 35 (19.6%)
Severe local disease was clearly the primary choice by the vast majority of adult practitioners; bacteremia was listed as the primary complication by only 45 members (13%) and ‘None’ was listed as the primary complication by 38 members (11%). Bacteremia was the clear choice for second most common complication, with osteomyelitis other (non-vertebral) listed only 34 times (14%). The complication rank ordered third was more diverse, with pneumonia barely edging out necrotizing fasciitis (N=34, 19%) and bacteremia (N=30, 17%). Other listed complications included: death, endocarditis, renal carbuncle, splenic abscess, meningitis/brain abscess, endophthalmitis, Fourniere’s gangrene, hypotension, IVC thrombosis, lymphadenitis, pericarditis, arthroplasty infection, septic arthritis, sinusitis, acute cholecystitis, bone/joint, bursitis, cellulitis, discitis, iliopsoas abscess, empyema, infected hardware (pacemakers), toxic shock syndrome (listed 3 times), necrotizing myositis, pyomyositis, recurrences (listed 6 times), retro-orbital abscess, septic thrombophlebitis.
What antimicrobial agent(s) are you most like to prescribe for an OUTPATIENT with a recurrent case of SSTI caused by MRSA?
Primary treatment choice (N=354):
trimethoprim/sulfamethoxazole by 224 (63.3)
doxycycline by 41 (11.6)
clindamycin by 30 (8.5)
minocycline by 24 (6.8)
linezolid by 17 (4.8)
none, or I&D only-no antibiotics by 8 (2.3)
other by 7 (2)
fluoroquinolone by 2 (0.6)
rifampin by 1 (0.3)
If you use a second agent, what is it? (N=328)
rifampin by 114 (34.8)
clindamycin by 53 (16.2)
doxycycline by 53 (16.2)
trimethoprim/sulfamethoxazole by 46 (14.0)
linezolid by 26 (7.9)
minocycline by 24 (7.3)
other by 4 (1.2)
none, or I&D only-no antibiotics by 5 (1.4)
fluoroquinolone by 4 (1.2)
Twenty-six members used one agent alone: trimethoprim/sulfamethoxazole (N=13), doxycycline (N=5), clindamycin (N=3), minocycline (N=2), linezolid (N=1), fluoroquinolone (N=1), vancomycin (N=1), daptomycin (N=1), rifampin (N=1), none (N=1).
The most common combination was trimethoprim/sulfamethoxazole plus rifampin (N=66), followed by trimethoprim/sulfamethoxazole plus doxycycline (N=53), trimethoprim/ sulfamethoxazole plus clindamycin (N=39), and trimethoprim/sulfamethoxazole plus linezolid (N=22). Other combinations used by at least 10 physicians were: trimethoprim/ sulfamethoxazole plus minocycline (N=16) and minocycline plus rifampin (N=11).
Duration of treatment for regimen specified: Many EIN members indicated an average duration of treatment, then added that it depends – until healing, on the severity, whether drainage has occurred, on clinical improvement, or some other variation of this theme. 13 (3.9%) individuals did not specify any duration of treatment, but indicated only (for example) ‘long enough…’.
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82.9% of EIN members usually prescribe treatment for patients with MRSA SSTI lasting 7-14 days.
What percent of your patients have at least one recurrence after initial treatment?
Mean 28.4% (SD 23.1)
Median 20%
Mode 20%
Range 0 (N=20) to 100 (N=4)
In the case of recurrent disease with the same susceptibility pattern, would you:
Use a new antimicrobial agent(s) 74 (21.8)
Use the same agent(s) for the same length of time 118 (34.7)
Use the same antimicrobial agent(s) for a longer period of time 148 (43.5)
Does your microbiology lab perform D tests on erythromycin-resistant, clindamycin-susceptible MRSA isolates?
Yes 295 (83.8)
No 36 (10.2)
Don’t know 21 (6.0)
Do you (or would you) modify your therapy based on a positive D test result?
Yes 302 (88.6)
No 39 (11.4)
Subset Analysis of Adult Practitioners who Reported Recurrence Rates of ≤5% (N=54)
What antimicrobial agent(s) are you most like to prescribe for an OUTPATIENT with a recurrent case of SSTI caused by MRSA?
Only four members used one agent alone: trimethoprim/sulfamethoxazole (N=2), clindamycin (N=1), vancomycin (N=1).
The most common combination was trimethoprim/ sulfamethoxazole plus clindamycin (N=10), followed by trimethoprim/sulfamethoxazole plus rifampin (N=8) and trimethoprim/sulfamethoxazole plus doxycycline (N=8). Other combinations included:
clindamycin plus linezolid (N=4)
trimethoprim/sulfamethoxazole plus linezolid (N=3)
clindamycin plus doxycycline (N=2)
trimethoprim/sulfamethoxazole plus doxycycline plus rifampin (N=3)
trimethoprim/sulfamethoxazole plus doxycycline plus clindamycin (N=2)
Other regimens were used only by one physician (N=10)
Duration of treatment tended to be longer with this subset, with 29 (53.7%) prescribing between 10-14 days and 17 (31.5%) prescribing at least 2 weeks. The shortest duration in this group was 5-7 days by one practitioner.
When asked about treatment of recurrent disease with the same susceptibility pattern, these individuals were more likely to treat with the same agent for a longer time (N=21) or with a new agent (N=17), and less likely to treat with the same agent for the same period of time (N=9).
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