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Original Investigation |

Reversion of Methicillin-Resistant Staphylococcus aureus Skin Infections to Methicillin-Susceptible Isolates

Anisha B. Patel, MD1,2; Emma Hill, BA1; Eric L. Simpson, MD1; Jon M. Hanifin, MD1
[+] Author Affiliations
1Department of Dermatology, Oregon Health & Science University, Portland
2now with the Department of Dermatology, University of Texas Medical Branch, Galveston
JAMA Dermatol. 2013;149(10):1167-1171. doi:10.1001/jamadermatol.2013.4909.
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Importance  The rise of methicillin-resistant Staphylococcus aureus (MRSA) infections in the outpatient setting has led to a growing trend of empirical antibiotic treatment for MRSA. The limited oral antibiotics available and the growing resistance to these antibiotics make this a controversial practice.

Objective  To determine the frequency of patients with MRSA skin and soft-tissue infections (SSTIs) reverting to methicillin-susceptible Staphylococcus aureus (MSSA) positivity.

Design and Setting  Retrospective medical record review of inpatients and outpatients from our university hospital and clinics between January 1, 2000, and December 31, 2010.

Participants  Patients in our institutional microbiological database were included if they had a MRSA-positive SSTI and subsequent culture-proven S aureus SSTI more than 1 month later. No sociodemographic restrictions were applied. A sample of at least 200 patients meeting the above criteria was desired. The database was sorted by ascending medical record number, with the first 1681 patients’ medical records reviewed. Of these, 215 patients met our criteria.

Main Outcomes and Measures  Whether a patient remained MRSA positive in subsequent SSTIs or reverted to MSSA-positive infections.

Results  Of the total 215 patients, 64 (29.8%) had at least 1 incident of MSSA reversion, and 55 (25.6%) reverted to MSSA infections for the remainder of the study. We assessed various factors that might increase or decrease the likelihood of reversion. The presence of an invasive device was the only factor to demonstrate a statistically significant risk (relative risk, 1.20; 95% CI, 1.02-1.41; P = .03) toward remaining MRSA positive in subsequent infections.

Conclusions and Relevance  Patients with MRSA SSTIs demonstrated the ability to revert to subsequent MSSA SSTIs with a significant frequency. Further study regarding MRSA risk factors and their effects on subsequent infections would be valuable in guiding empirical treatment. Reculturing new infections in previously MRSA-positive patients is a prudent management strategy as we recognize that susceptibilities of the S aureus organisms change.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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