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Title: The rise of methicillin resistant Staphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia.
Authors: Macmorran, E
Harch, S
Athan, E
Lane, S
Tong, S
Crawford, L
Krishnaswamy, S
Hewagama, S
Affiliation: Alice Springs Hospital,Northern Territory,Australia..
Alice Springs Hospital,Northern Territory,Australia..
Infectious Diseases,Barwon Health,Geelong,Victoria,Australia..
Infectious Diseases,Barwon Health,Geelong,Victoria,Australia..
Victorian Infectious Diseases Service,The Royal Melbourne Hospital, and the University of Melbourne at the Peter Doherty Institute for Infection and Immunity,Victoria,Australia..
Alice Springs Hospital,Northern Territory,Australia..
Alice Springs Hospital,Northern Territory,Australia..
Alice Springs Hospital,Northern Territory,Australia..
Issue Date: 2017
Citation: Epidemiology and infection 2017; 145(13): 2817-2826
Abstract: This study aimed to examine the epidemiology and treatment outcomes of community-onset purulent staphylococcal skin and soft tissue infections (SSTI) in Central Australia. We performed a prospective observational study of patients hospitalised with community-onset purulent staphylococcal SSTI (n = 160). Indigenous patients accounted for 78% of cases. Patients were predominantly young adults; however, there were high rates of co-morbid disease. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was the dominant phenotype, accounting for 60% of cases. Hospitalisation during the preceding 6 months, and haemodialysis dependence were significant predictors of CA-MRSA infection on univariate analysis. Clinical presentation and treatment outcomes were found to be comparable for methicillin-susceptible S. aureus (MSSA) and methicillin-resistant cases. All MRSA isolates were characterised as non-multi-resistant, with this term used interchangeably with CA-MRSA in this analysis. We did not find an association between receipt of an active antimicrobial agent within the first 48 h, and progression of infection; need for further surgical debridement; unplanned General Practitioner or hospital re-presentation; or need for further antibiotics. At least one adverse outcome was experienced by 39% of patients. Clindamycin resistance was common, while rates of trimethoprim-sulfamethoxazole resistance were low. This study suggested the possibility of healthcare-associated transmission of CA-MRSA. This is the first Australian report of CA-MRSA superseding MSSA as the cause of community onset staphylococcal SSTI.
DOI: 10.1017/S0950268817001716
Type: Journal Article
Subjects: Staphylococcus aureus
Community epidemics
Methicillin - S. aureus resistant to (MRSA)
Public health microbiology
Soft tissue infections
Anti-Bacterial Agents
Community-Acquired Infections
Methicillin-Resistant Staphylococcus aureus
Microbial Sensitivity Tests
Middle Aged
Northern Territory
Soft Tissue Infections
Staphylococcal Infections
Staphylococcal Skin Infections
Young Adult
Methicillin Resistance
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