Abstract
BackgroundClinicians often prescribe antimicrobials for outpatient wound infections before culture results are known. Local or national MRSA rates may be considered when prescribing antimicrobials. If clinicians prescribe in response to national rather than local MRSA trends, prescribing may be improved by making local data accessible. We aimed to assess the correlation between outpatient trends in antimicrobial prescribing and the prevalence of MRSA wound infections across local and national levels.MethodsMonthly MRSA positive wound culture counts were obtained from The Surveillance Network, a database of antimicrobial susceptibilities from clinical laboratories across 278 zip codes from 1999–2007. Monthly outpatient retail sales of linezolid, clindamycin, trimethoprim-sulfamethoxazole and cephalexin from 1999–2007 were obtained from the IMS Health XponentTM database. Rates were created using census populations. The proportion of variance in prescribing that could be explained by MRSA rates was assessed by the coefficient of determination (R2), using population weighted linear regression.Results107,215 MRSA positive wound cultures and 106,641,604 antimicrobial prescriptions were assessed. The R2 was low when zip code-level antimicrobial prescription rates were compared to MRSA rates at all levels. State-level prescriptions of clindamycin and linezolid were not correlated with state MRSA rates. The variance in state-level prescribing of clindamycin and linezolid was correlated with national MRSA rates (clindamycin R2 = 0.17, linezolid R2 = 0.22).ConclusionsClinicians may rely on national, not local MRSA data when prescribing clindamycin and linezolid for wound infections. Providing local resistance data to prescribing clinicians may improve antimicrobial prescribing and would be a possible target for future interventions.
Highlights
Clinicians often prescribe antimicrobials for outpatient wound infections before culture results are known
The Infectious Diseases Society of America (IDSA) and U.S Centers for Disease Control and Prevention recommend empirical coverage aimed at community-associated Methicillin-resistant Staphylococcus aureus (MRSA) for outpatient wound infections if MRSA is common in that community
Antimicrobial prescribing at the zip code level was not correlated with zip code, state or national MRSA infection rates (R2 < 0.10) for clindamycin, linezolid, trimethoprimsulfamethoxazole or cephalexin
Summary
Clinicians often prescribe antimicrobials for outpatient wound infections before culture results are known. The Infectious Diseases Society of America (IDSA) and U.S Centers for Disease Control and Prevention recommend empirical coverage aimed at community-associated MRSA for outpatient wound infections if MRSA is common in that community. This empiric coverage includes clindamycin, trimethroprim-sulfamethoxazole, or linezolid [2,3,4,5,6,7]. If these rates are not known or difficult to access, clinicians may be forced to rely solely on national MRSA trends
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
