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Community-Acquired Skin Infections in the Age of Methicillin-Resistant Organisms

Table 1. Summary of interventions by office

Office

Intervention

The Country Doctor, Bloomfield
Dr. Brodale

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds)

Manchester Family Medicine Associates, Guttenberg
Dr. Hoffman

CDC Algorithm for MRSA Treatment (will put on EMRelectronic medical record)
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)
Office policy for patients with skin infections

Genesis Medical Center, Blue Grass
Dr. Bunting

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

Genesis Medical Center, Davenport
Dr. Andresen

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

Medical Associates, Le Mars
Dr. Doorenbos

CDC Algorithm for MRSA Treatment
Office policy for patients with skin infections (extant)
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

Regional Family Health, Manchester
Dr. Boom

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

University of Iowa Hospitals and Clinics CMS Lone Tree Clinic, (Moved to Riverside on March 15, 2010)
Dr. Bedell

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

University of Iowa Hospitals and Clinics CMS Sigourney Clinic
Dr. Saxena

CDC Algorithm for MRSA Treatment
Office skin infection management protocol
Education forms (MRSA Fact Sheet, & Caring for Wounds)
Office skin infection management protocol

University of Iowa Hospitals and Clinics Family Medicine Clinic, Iowa City
Dr. Wilbur

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

Urbandale Family Physicians, Urbandale
Dr. Shirk

CDC Algorithm for MRSA Treatment
Education forms (MRSA Fact Sheet, Caring for Wounds, Wound Packing Instructions)

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Table 2. Skin infection forms received by study site

IRENE Office (Office No.)

City

City Population

No. of Skin and Soft Tissue Forms Returned

The Country Doctor (6)

Bloomfield

2,601

21

Family Medicine Associates (3)

Guttenberg

1,987

30

Genesis Family Medicine (1)

Davenport

98,359

31

Genesis Family Medicine (2)

Blue Grass

1,169

30

Manchester Family Medical Associates (4)

Manchester

5,257

30

Medical Associates (5)

Le Mars

9,237

30

University of Iowa Hospitals and Clinics CMS Riverside Clinic (7)

Riverside

928

30

University of Iowa Hospitals and Clinics CMS Sigourney Clinic (8)

Sigourney

2,209

33

University of Iowa Hospitals and Clinics Family Medicine Clinic (9)

Iowa City

62,220

30

Urbandale Family Physicians (10)

Urbandale

29,072

30

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Table 3. Demographic characteristics by clinic site

ClinicNo. Useable Skin
and Soft Tissue
Infection Forms		Male
n (%)		Uninsured
n (%)		Mean Age
(Years)		Rural County
n (%)

1

25

7 (28)

1 (4)

40

0

2

26

12 (46)

0

40

0

3

26

14 (54)

1 (4)

53

25 (96)

4

26

4 (15)

1 (4)

44

1 (4)

5

29

22 (76)

6 (21)

39

0

6

21

12 (57)

3 (16)

30

20 (95)

7

25

16 (64)

3 (12)

46

9 (36)

8

26

17 (68)

0

35

25 (100)

9

30

11 (37)

1 (3)

38

0

10

30

17 (57)

2 (7)

43

0

Total

263

132 (50%)

18 (7)

41

80 (30)

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Table 4. Demographic summary of retrospective study subjects

Demographics (N = 263)

N (%)

Age (years)
   > 20
   20-39
   40-64
   ≥ 65


60 (23)
66 (25)
88 (34)
48 (18)

Male

132 (50)

Caucasian

191 (96)

Hispanic

10 (5)

Insurance coverage
   Private
   Medicaid
   Medicare
   Uninsured


152 (59)
44 (17)
44 (17)
18 (7)

Lives in rural county

80 (30)

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Table 5. Skin infection type, incision and drainage done, culture sent, initial antibiotic prescribed, and MRSA in wound for retrospective subjects

Clinic

No. Useable Skin
and Soft Tissue
Infection Forms n (%)

Abscess
Only
n (%)

Cellulitis
Only
n (%)

Both Abscess & Cellulitis
n (%)

Incision and Drainage Done
n (%)

Culture Sent
n (%)

Initial antibiotic prescribed
n (%)

MRSA positive
(n)

1

25

22 (88)

0

3 (12)

25 (100)

5 (20%)

16 (64)

2

2

26

13 (50)

13 (50)

0

10 (39)

0

25 (96)

0

3

26

4 (15)

16 (62)

6 (23)

6 (23)

10 (39)

26 (100)

1

4

26

2 (8)

20 (77)

4 (15)

3 (12)

4 (15)

26 (100)

0

5

29

12 (41)

12 (41)

5 (18)

10 (35)

19 (66)

28 (97)

19

6

21

7 (33)

10 (48)

4 (19)

7 (33)

13 (62)

21 (100)

5

7

25

5 (20)

20 (80)

0

3 (12)

3 (12)

23 (92)

0

8

25

2 (8)

19 (76)

4 (16)

3 (12)

16 (64)

24 (96)

8

9

30

12 (40)

17 (57)

1 (3)

6 (20)

11 (37)

30 (100)

6

10

30

15 (50)

14 (47)

1 (3)

13 (43)

11 (37)

29 (97)

4

Total

263

94 (36)

141 (54)

28 (11)

86 (32)

92 (35)

248 (94)

      45

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Table 6. Treatment according to infection type, retrospective data

 

Abscess Only
n = 93
n (%)

Cellulitis Only
n = 143
n (%)

Both Abscess and Cellulitis
n = 27
n (%)

P-value

Incision and drainage

68 (73)

Not applicable

15 (56)

0.082

Wound packed

22 (24)

Not applicable

8 (30)

0.126

Cultured

40 (43)

34 (24)

18 (67)

<0.001

MRSA identified

25 (27)

9 (6)

11 (41)

<0.001

Any antibiotic prescribed at the initial visit

81 (87)

138 (97)

27 (100)

0.006

Number of antibiotics used until infection healed
   0
   1
   2
   3
   4
   5

 
11 (12)
60 (65)
16 (17)
5 (5)
1 (1)
0

 
4 (3)
103 (72)
25 (18)
7 (5)
2 (1)
2 (1)


0
13 (48)
9 (33)
4 (15)
0
1(4)

0.015

Total number of antibiotics prescribed:
    > 2
    ≤ 2


6 (7)
8 (93)


11 (8)
132 (92)


5 (19)
22 (81)

0.125

First or second antibiotic prescribed at initial visit covered MRSA

35 (43)

24 (17)

11 (41)

<0.001

MRSA coverage at any time

44 (54)

35 (25)

12 (44)

<0.001

Mean time (days) to resolution

10.5 (6.1)

12.3 (8.1)

14.0 (8.6)

0.059

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Table 7. Abscess treatment by incision and drainage done versus not, retrospective data

 

Abscess Only
Incised and Drained
N = 68
N (%)

Abscess Only
Not Incised and Drained
N = 25
N (%)

P-value

Wound packed

22 (100)

Not applicable

 

Cultured

31 (46)

9 (36)

0.408

MRSA identified (of those cultured)

16 (24)

9 (36)

0.032

Any antibiotic prescribed at the initial visit

56 (82)

25 (100)

0.024

Number antibiotics used
   0
   1
   2
   3
   4


11 (16)
41 (60)
13 (19)
2 (3)
1 (2)


0
19 (76)
3 (12)
3 (12)
0

0.077

Total number of antibiotics prescribed:
> 2
≤ 2


3 (4)
65 (96)


3 (12)
22 (88)

0.187

First or second antibiotic prescribed at initial visit covered MRSA

26 (46)

9 (36)

0.381

MRSA coverage at any time

32 (56)

12 (48)

0.496

Mean time to resolution (days)

9.6 (5.3)

12.8 (7.5)

0.059

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Current as of March 2011
Internet Citation: Community-Acquired Skin Infections in the Age of Methicillin-Resistant Organisms. March 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/mrsa/iowa_mrsatabs1-7.html