Introduction: Skin and soft tissue infections with methicillin-resistant Staphylococcus aureus (MRSA) have increased in frequency and severity in most hospitals resulting in greater need for admissions and surgical management.

Background: We hypothesized that a lack of awareness for the presence of this infection compounded by a prolonged period before cultures could identify this drug-resistant pathogen has led to inadequate therapy and increased length of stay.

Methods: We retrospectively reviewed the management of all 217 patients with skin and soft tissue infections that cultured MRSA in two inner city hospitals from January 2008 to October 2009. Patients were assessed for age, gender, antibiotic use during inpatient hospitalization, time to appropriate antibiotic therapy, surgical management (incision and drainage; excisional debridement), and length of inpatient hospitalization.

Results: The age range for the patients was 1 month to 95 years (mean age=39.6 years) with a male to female ratio of 1.8 to 1. Five patients infected with MRSA never received any antibiotics, and three of those patients underwent surgical drainage without antibiotic therapy. Of patients with MRSA culture-positive soft tissue infections who were treated with antibiotics, 73 (34%) were initially treated with an antibiotic that did not cover MRSA. Twelve patients never received appropriate antibiotic coverage during their hospitalization. For the 61 patients who were changed to an antibiotic that covered MRSA, the average time to appropriate therapy was 67.5 hours (95% C.I. 59.5-75.6). Of 169 patients treated with surgical management, 47 (28%) patients received delayed surgical therapy defined as greater than 24 hours after initial hospital presentation. The inpatient length of hospitalization was increased for those patients who received delayed surgical management of MRSA soft tissue infections (12.3 days; 95% CI 7.2-17.3) compared to patients who received timely surgical drainage or debridement (7.5 days; 95% CI 5.9-9.2). Of the 43 pediatric patients (age < 18 yrs) who received antibiotic therapy, 14 (32%) initially received antibiotics that did not cover MRSA; of those 14 patients, 4 patients never received antibiotics that covered MRSA during their entire hospitalization. The mean time to appropriate therapy for the other 10 pediatric patients was 43.2 hours (95% CI 38.7-47.8). Of 32 pediatric patients treated surgically, 11 (32%) patients received surgical therapy in a delayed fashion.

Conclusion: Many patients with MRSA skin and soft tissue infections receive inappropriate antibiotic and delayed surgical therapies. Appropriate management of these infections, particularly in the pediatric population, may lead to decreased length of hospitalization. Prospective evaluation of a larger patient population will provide further data on this topic, and earlier diagnosis may lead to improved awareness and treatment of MRSA soft tissue infections.