A Prospective Investigation of Outcomes after Hospital Discharge for Endemic, Community-Acquired Methicillin-Resistant and -Susceptible Staphylococcus aureus Skin Infection

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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. 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. 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). 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.