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Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

Published online by Cambridge University Press:  04 March 2015

Bjug Borgundvaag ,
Wil Ng ,
Brian Rowe ,
Kevin Katz  and
on the behalf of EMERGency Department Emerging Infectious Disease Surveillance NeTwork (EMERGENT) Working Group
Bjug Borgundvaag*
Affiliation:
Department of Family and Community Medicine, University of Toronto, Mount Sinai Hospital Schwartz/Reisman Emergency Centre, Toronto, ON Faculty of Medicine, University of Toronto, Toronto, ON
Wil Ng
Affiliation:
Infection Prevention and Control, North York General Hospital, Toronto, ON
Brian Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB
Kevin Katz
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, ON Infection Prevention and Control, North York General Hospital, Toronto, ON
on the behalf of EMERGency Department Emerging Infectious Disease Surveillance NeTwork (EMERGENT) Working Group
Affiliation:
Department of Emergency Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB
*
Mount Sinai Hospital, 600 University Avenue, Room 206, Toronto, ON M5G 1X5; b.borgundvaag@utoronto.ca

Abstract

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Background:

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs.

Methods:

Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grew S. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes.

Results:

Of the 1,353 S. aureus–positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptible S. aureus. We observed significant variation in both the prevalence of MRSA (11–100%) and the proportion of community-associated strains of MRSA (0– 100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada.

Interpretation:

MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.

Keywords

community-associated methicillin-resistant Staphylococcus aureusmethicillin-resistant Staphylococcus aureussoft tissue infectionStaphylococcus aureus
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 3 , May 2013 , pp. 141 - 160
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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