Factors affecting the rise of treatment of resistant bacteria in skin and soft tissue infections in the United States: 1993–2012

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) prevalence has been steadily increasing for the past 40 years. The increase in such infections has contributed to a change in the treatment patterns of the patient. This study aimed to detail the factors determining prescription practices associated with MRSA-related skin and soft tissue infections.Methods: The National Ambulatory Medical Care Survey (NAMCS) was searched for data from 1993 to 2012 regarding the factors associated with resistant vs. non-resistant-antibiotic prescription.Results: Of all physician visits, 34.0% received resistant-antibiotic therapy and 66.0% received non-resistant-antibiotic therapy. Prescription of antibiotic-resistant therapy increased over the time period studied (Odds ratio (OR) = 1.07; 95% CI 1.05, 1.09; p < .0001). Logistic regression controlling for age, sex, race, region, metropolitan statistical area (MSA), infection type, physician specialty, number of medications and number of diagnoses found that region, infection type and physician specialty were factors in the prescription patterns of SSTIs. In the Northeast, patients were less likely to be prescribed resistant-antibiotics (OR = 0.25; 0.12, 0.53; p = .0003), non-primary care physicians were more likely to prescribe resistant-antibiotics (OR = 2.89; 1.75, 4.77; p < .0001), and patients presenting with folliculitis were more likely to be prescribed resistant antibiotics (OR = 3.03; 1.30, 7.05; p = .01).Conclusions: With the increasing prevalence of MRSA-related SSTIs, the treatment of these infections is changing. Understanding of the factors contributing to the prescription of resistant antibiotics could aid in the selection of appropriate treatment of SSTIs, and hopefully, avoidance of development of additionally resistant organisms.