A prospective investigation of outcomes after hospital discharge for endemic, community-acquired methicillin-resistant and -susceptible Staphylococcus aureus skin infection

Clin Infect Dis. 2007 Feb 15;44(4):483-92. doi: 10.1086/511041. Epub 2007 Jan 12.


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; P=.55). Lack of incision and drainage was associated with nonresponse at day 30 (P=.005), 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 (P=.003) and to believe subjectively that they had not been cured (P=.002) 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; P=.2).

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Anti-Infective Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / epidemiology
  • Confidence Intervals
  • Endemic Diseases*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Methicillin Resistance*
  • Microbial Sensitivity Tests
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Probability
  • Prospective Studies
  • Recurrence
  • Sex Distribution
  • Staphylococcal Skin Infections / diagnosis
  • Staphylococcal Skin Infections / drug therapy*
  • Staphylococcal Skin Infections / epidemiology*
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification
  • Treatment Outcome


  • Anti-Infective Agents