Emergency Department Visits for Skin Infections Increasing Dramatically

WASHINGTON, D.C. -- A paper appearing online today in the Annals of Emergency Medicine suggests that emergency department visits for skin infections have increased since a new strain of staph was discovered, but downplays the danger of the new staph. The paper is titled Increased U.S. Emergency Department Visits for Skin and Soft Tissue Infections, and Changes in Antibiotic Choices, During the Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA). An accompanying editorial, MRSA: Deadly Super Bug or Just Another Staph? says widespread fears about CA-MRSA have been drastically overplayed

Community-associated MRSA has been in the news lately as the cause of locker room outbreaks and even a few deaths.  CA-MRSA was first discovered in the mid-1990s; before then, MRSA was seen only in hospitalized patient and was referred to as healthcare-associated MRSA.

Our research shows that CA-MRSA has emerged as the most common cause of abscesses among otherwise healthy patients coming to the emergency department across the country, said Daniel J. Pallin, MD, MPH, of the Departments of Emergency Medicine at Brigham and Womens Hospital and Childrens Hospital, in Boston. The number of emergency department visits for skin infections has risen dramatically since the new strain of CA-MRSA was discovered, but most cases are not life-threatening.  While the increasing numbers of infections suggest that we are seeing an epidemic, it is an epidemic of mild illness for the most part, and reports of deadly complications are the exception more than the rule. 

In an editorial accompanying Pallins article, David A. Talan, MD, of the Department of Emergency Medicine at UCLAMedicalCenter in Los Angeles, acknowledges the rise in infections is cause for concern, but takes issue with the media frenzy over CA-MRSA.

Community-associated MRSA is not a deadly super bug, said Talan. It is more like an aggressive honeybee: more apt to sting, but only rarely fatal.  Patients with MRSA should be reassured that they have a good prognosis and good treatment options.  The risk of death in 2005 from CA-MRSA was approximately equal to the risk of dying from forces of nature.

Pallin and his team assessed data from 1993 through 2005 and found that visits to U.S. emergency departments for skin infections almost tripled, from 1.2 million in 1993, to 3.4 million in 2005. They also found that when doctors prescribe antibiotics for skin infections, they are likely to use an inexpensive old antibiotic called Bactrim, a sulfa drug. The researchers emphasized that newer antibiotics should be conserved, because the more they are used, the more likely bacteria is to develop resistance to them. 

Many patients with CA-MRSA do not need an antibiotic at all, as their abscesses will heal naturally following incision and drainage, said Pallin.  And for the patient whose abscess does require antibiotics, Bactrim is probably the best choice.

The researchers emphasized the value of surveillance, saying that the increase in MRSA cases has resulted in a significantly increased burden of disease that will require additional attention and resources.

This is a major public health problem that we need to keep an eye on, said Pallin.  Having said that, the public should not be unduly alarmed by sensational stories.  People with skin infections should see their primary care doctors within a day or two.  If thats not possible, emergency departments are available 24/7, and emergency physicians are quite familiar with these infections.

Source: American College of Emergency Physicians