Methicillin resistant Staphylococcus Aureus in emergency department patients in the United Arab Emirates

Muna Al Jalaf,Hanan Fadali,Rasha Alanee,Eric J Nilles,Rania M Seliem,Firas Najjar,Zulfa Al Deesi

doi:10.1186/s12873-018-0164-7

Abstract

BackgroundSince the 1990s, community-associated methicillin resistant staphylococcus aureus (CA-MRSA) has emerged as an important global cause of skin and soft tissue infections. Little is known about the epidemiology of this pathogen in the Middle East.MethodsWe conducted a prospective observational study in a single large teaching hospital in Dubai to identify the incidence of community-acquired methicillin resistant staphylococcus aureus (MRSA) among ambulatory patients presenting with purulent skin and soft tissue infections. We performed wound cultures and administered standard questionnaires to 100 cases presenting to the emergency department. Bivariate and multivariate analyses were performed to identify risk factors for MSRA versus other pathogens.ResultsThe prevalence of MRSA was 23% (18/78) among 78 culture-positive isolates and 29% (18/62) among Staphylococcus-positive isolates. 74% received antibiotics of which 4/74 (5%) received antibiotics appropriate for CA-MRSA infections. Multivariate adjusted analysis identified playing contact sports (OR 5.9 [95% CI 1.3–27.1]) and female sex (OR 6.3 [95% CI 1.6–24.8]) as independent risks for MRSA infection.ConclusionsThis is the first study to describe the epidemiology of CA-MRSA in the ambulatory setting in the Middle East and demonstrates a substantial proportion of cases presenting with skin and soft tissue infections were CA-MRSA. Although most skin and soft tissue infections are abscesses for which the cornerstone of treatment is high quality incision and drainage, if adjunct antibiotics are prescribed in this setting, CA-MRSA-active antibiotics should be considered.

Highlights

Since the 1990s, community-associated methicillin resistant staphylococcus aureus (CA-MRSA) has emerged as an important global cause of skin and soft tissue infections
We defined community-acquired MRSA according to United States Centers for Disease Control and Prevention criteria: (1) Positive culture for MRSA as an outpatient or within 48 h of hospital admission; (2) No medical devices or indwelling catheters that are permanently placed though the skin; (3) No history of MRSA infections; and (4) No recent history of hospitalization or residence in nursing home or long-term care facility
Between January 2011 and June 2012, patients with purulent Skin and soft tissue infection (SSTI) infections were enrolled in the study and provided culture samples; 75 (75%) were male with a median age of 30; 74 (74%) were expatriates and 26% Emirati nationals

Summary

Introduction

Since the 1990s, community-associated methicillin resistant staphylococcus aureus (CA-MRSA) has emerged as an important global cause of skin and soft tissue infections. Little is known about the epidemiology of this pathogen in the Middle East. During the 1990s community-acquired MRSA (CA-MRSA) emerged in populations without exposure to health facilities and without traditional risk factors for MRSA [1, 2]. CA-MRSA has emerged as a major global cause of purulent skin and soft tissues infections but little is known about the epidemiology of CA-MRSA in the Middle East [3,4,5] and no studies in the region have examined the prevalence of CA-MRSA in ambulatory settings. A secondary objective was to identify risk factors and clinical features of MRSA.

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