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Antibiotic Harm - MRSA, the Super Bug

This article is posted in: 

What's the Relationship Between Using Antibiotics and Then Getting MRSA?

RE: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) such as in an abscess or cellulitis–- the more the antibiotic exposure prior to getting MRSA, the more likely it was you would get MRSA.

Setting and Study Design  A population-based case-control study in children, 1 to 19 years of age using a primary care, General Practice Research Database, United Kingdom, 1994-2007.

Participants  Cases were children who had MRSA diagnosed as outpatients, and controls were individually matched on age and practice, with the matched case's diagnosis date as the index date for both.

Main Exposures  Antibacterial agents prescribed 180 to 30 days prior to the index date, excluding prescriptions 30 days before the index date to prevent protopathic bias.

Outcome Measures  Rate ratios (RRs) estimated from the odds ratios of exposure in cases compared with controls using conditional logistic regression, adjusted for comorbid conditions, other prescription drug use, and hospitalization.

Results  The rate of MRSA was 4.5 per 100 000 per year. Of 297 cases and 9357 controls, 52.5% and 13.6%, respectively, received antibacterial drug prescriptions during the 150-day exposure window. The adjusted RR with any antibacterial drug was 3.5 (95% confidence interval [CI], 2.6-4.8). The RRs increased with the number of prescriptions (2.2 [95% CI, 1.5-3.2], 3.3 [95% CI, 1.9-5.6], 11.0 [95% CI, 5.6-21.6], and 18.2 [95% CI, 9.4-35.4] for 1, 2, 3, and 4 prescriptions, respectively). The RR was particularly elevated for quinolones at 14.8 (95% CI, 3.9-55.8), with wide variation among antibacterial classes.

Conclusion  While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs, such agents are associated with a dose-dependent increased risk, concordant with findings in adults.

Schneider-Lindner Quach C, Hanley JA, Suissa S.  "Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children." Arch Pediatr Adolesc Med. Published online August 1, 2011. doi:10.1001/archpediatrics.2011.143

See also, the following, excellent, 'how to manage' articles: 

Singer AJ, Talan DA. "Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus." N Engl J Med 2014; 370:1039-1047March 13, 2014DOI: 10.1056/NEJMra1212788

Fitch MT, Manthey DE, McGinnis HD, Nicks, BA, Pariyadath M. "Abscess Incision and Drainage." N Engl J Med 2007; 357:e20November 8, 2007DOI: 10.1056/NEJMvcm071319