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15 February 2007

Volume 44, Number 4
Clinical Infectious Diseases 2007;44:483–492
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4404-0002$15.00
DOI: 10.1086/511041
MAJOR ARTICLE

A Prospective Investigation of Outcomes after Hospital Discharge for Endemic, Community‐Acquired Methicillin‐Resistant and ‐Susceptible Staphylococcus aureus Skin Infection

Loren G. Miller,1,3,4

Clifford Quan,2

Anthony Shay,1,3,4

Katayoun Mostafaie,2,4

Kiran Bharadwa,6

Nelly Tan,4,5

Kelli Matayoshi,1,3

Jason Cronin,1,3,4

Jennifer Tan,1,3

Grace Tagudar,1,3 and

Arnold S. Bayer1,3,4

Divisions of 1Infectious Diseases and 2General Internal Medicine and 3Los Angeles Biomedical Research Institute, Harbor–University of California–Los Angeles Medical Center, Torrance, 4David Geffen School of Medicine at the University of California, Los Angeles, and 5University of California, Riverside, California; and 6School of Medicine and Biomedical Sciences, State University of New York, Buffalo

Background.Although community‐acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) infection has become increasingly common, prospective data on outcomes of patients with skin infection remain poorly defined.

Methods.We prospectively observed a cohort of 201 patients discharged after hospitalization for CA‐MRSA infection or community‐acquired methicillin‐susceptible S. aureus (CA‐MSSA) infection. Patients were interviewed 30 and 120 days after they received a diagnosis. Our primary outcome was clinical response, defined as no relapse, new S. aureus infection, or need for antibiotics at day 30.

Results.Among 117 patients with skin infection, the nonresponse rate at day 30 was similar among patients with CA‐MRSA infection and those with CA‐MSSA infection (23 [33%] of 70 vs. 13 [28%] of 47 patients; ). Lack of incision and drainage was associated with nonresponse at day 30 ( ), but other clinical factors, including receipt of antibiotics inactive against the infecting strain, were not. Patients with CA‐MSSA infection were more likely to be rehospitalized ( ) and to believe subjectively that they had not been cured ( ) at day 30. At day 30, there was a trend for close contacts of CA‐MRSA–infected patients to develop a similar infection (13% vs. 4%; odds ratio, 3.3; 95% confidence interval, 0.7–15.8; ).

Conclusion.Although it is believed patients with CA‐MRSA skin infection may have more serious outcomes than those with CA‐MSSA skin infection, we found similar outcomes in these 2 groups after hospital discharge. Clinical nonresponse at day 30 was associated with a lack of receipt of incision and drainage. Our data also suggest that close contacts of persons with CA‐MRSA skin infection may have a higher likelihood of acquiring an infection.

Received 4 August 2006; accepted 7 November 2006; electronically published 12 January 2007.

Reprints or correspondence: Dr. Loren G. Miller, Div. of Infectious Diseases, Harbor‐UCLA Medical Center, 1000 W. Carson St., Box 466, Torrance, CA 90509 ().

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  • Presented in part: 43rd Annual Meeting of the Infectious Diseases Society of America, San Francisco, California, October 2005 (abstract 1059).

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