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Office Visits For Skin Infections Remain Unchanged

Ruzanna Harutyunyan's picture

Since the discovery of community-associated methicillin-resistant staphylococcus aureus, more commonly called MRSA, the emergency department visits for skin and soft-tissue infections (SSTI) increased from 1993-2005. In a new study, researchers from Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH) sought to determine if the number of SSTI visits also increased in the larger setting of physicians' offices.

They found that SSTI visits to physicians' offices have not become more common since the discovery of community-associated MRSA. These findings are published online and will appear in the September 15 print edition of Clinical Infectious Disease.

Community-associated MRSA is a type of staph infection that is resistant to certain antibiotics. Previous research indicated an increase in SSTI visits associated with community-associated MRSA in the emergency department setting, and also suggested an increase across all ambulatory medical settings.

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"In contrast with previous research, our study finds that SSTI visits to physicians' offices have not increased since the discovery of this ‘drug-resistant superbug' - community-associated MRSA," said Daniel Pallin, MD, MPH, lead author of the paper and Director of Research in the Department of Emergency Medicine at BWH.

Because dermatitis, a disease of the skin, is also thought to increase the risk of SSTI, the researchers analyzed office visits at which patients were diagnosed with dermatitis or an SSTI to determine if the two conditions were linked, and if the link became stronger since the discovery of community-associated MRSA. Using the National Ambulatory Medical Care Survey, data from 361,697 physicians' office visits were collected and the researchers calculated national estimates.

Pallin and colleagues found that dermatitis was diagnosed at 13 million office visits per year, and SSTI were diagnosed at 6.3 million visits per year, with the frequency of both diagnoses remaining unchanged over the study period of 13 years (1993-2005). They also found that dermatitis was associated with SSTI, but that the association did not strengthen over time, while community-associated MRSA became prevalent. The researchers also found that dermatitis is most commonly diagnosed in infants and small children, but that SSTI affect all age groups similarly.

"It appears that we are in the midst of an epidemic of skin and soft-tissue infections, likely due to community-associated MRSA. But we now know that the epidemic seems only to be affecting emergency department visit rates, not office visit rates. The reason for the disproportionate effect upon the emergency department is unknown. Though community-associated MRSA can rarely cause serious infections like pneumonia and septicemia, the importance of the epidemic should not be overblown, as most cases involve only mild superficial infections," Pallin said. He also emphasized that there is no evidence that skin infections require different treatment today than they did before the advent of community-associated MRSA, stating that "Abscesses are treated surgically, and usually do not require antibiotics, and cellulitis has not been shown to require antibiotics effective against community-associated MRSA."

Cellulitis is a form of skin infection that is different from abscess, and is the subject of a clinical trial being conducted at BWH, MGH, and Children's Hospital Boston, by Dr. Pallin and co-authors.