Dramatic rise in CA-MRSA: What it means for your ED

There is an alarming increase in community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cases in ED patients seeking treatment for skin and soft tissue infections, according to a new study.1

"Despite the well-documented emergence of CA-MRSA in the U.S., evidence of its prevalence among otherwise healthy emergency patients has not been explored," said lead author Bradley W. Frazee, MD, assistant clinical professor at the department of emergency medicine at Alameda County Medical Center in Oakland, CA.

Researchers found 51% of skin and soft tissue infections in Alameda’s ED were caused by CA-MRSA.

EDs see dramatic increase

While MRSA was once thought to be acquired mostly in health care facilities, a surge in patients with MRSA acquired in the community is being seen in ED waiting rooms, reports Frazee. "The good news is that compared to hospital-associated MRSA strains, community-associated MRSA is susceptible to a broader array of antibiotics," he says. "The bad news is that CA-MRSA may be more virulent than typical hospital strains."

Although researchers found few demographic similarities among the infected patients, the patients were more likely to be white, and their infections were more likely to take the form of a boil.

"We now need to consider what measures are needed to reduce its spread in the community as well as among ED patients," says Frazee. "Until we have detailed guidelines regarding how to handle likely CA-MRSA patients, standard universal precautions probably are adequate."

Once MRSA infection is identified, patients typically are isolated, but due to overcrowding in EDs, it may be difficult to isolate all of the CA-MRSA patients, he notes. "Remember, this bug is spreading naturally in the community, and it is associated for the most part with minor skin infections," says Frazee. "Most of these patients are not admitted, and as long nurses wear gloves and wash their hands, it is unlikely that the pathogen will spread to staff or between patients during a short-term ED stay."

[Editor’s note: For more information, contact: Bradley W. Frazee, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of California, San Francisco, Box 0208, San Francisco, CA. 94143-0208. Telephone: (510) 437-8323. Fax: (510) 437-8322. E-mail: bfrazee@hghed.com.]

Reference

1. Frazee BW, Lynn J, Charlebois ED, et al. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 2005: In press.