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Canadian Journal of Infectious Diseases
Volume 14 (2003), Issue 6, Pages 315-321
Original Article

A Retrospective Analysis of Practice Patterns in the Treatment of Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections at Three Canadian Tertiary Care Centres

John M Conly,1 H Grant Stiver,2 Karl A Weiss,3 Debbie L Becker,4 Andrew J Rosner,4 and Elizabeth Miller5

1Division of Infectious Diseases, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
2Division of Infectious Diseases, Department of Medicine, Vancouver Hospital and Health Sciences Center, University of British Columbia, Vancouver, British Columbia, Canada
3Infectious Diseases and Microbiology, University of Montreal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
4Health Economics and Outcomes Research, Innovus Research Inc, Burlington, Ontario, Canada
5Access and Outcomes Research, Pharmacia Canada, Mississauga, Ontario, Canada

Received 17 June 2003; Accepted 23 October 2003

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly being encountered and pose an increasing burden to the health care system in Canada.

OBJECTIVE: To elucidate and characterize the factors influencing the current MRSA treatment patterns in patients with skin and soft tissue infections (SSTIs) before linezolid became available on the Canadian market.

METHODS: A retrospective study collected demographic, treatment and resource use data on patients hospitalized at one of three geographically distinct tertiary care facilities, where MRSA SSTI treatment was initiated with intravenous (IV) vancomycin. Analysis of opportunities for IV-to-oral switch therapy was based on eligibility criteria.

RESULTS: Of 89 patients identified over a 43-month period, the mean (±SD) durations of anti-infective treatment and hospitalization were 22.4±21 days and 28.9±20.8 days, respectively. An infected surgical wound was most common, representing 62.9% of infections. The mean duration of vancomycin treatment was 19.5 days and the mean number of 1 g doses received was 29.0±32.9. The majority of patients (55.1%) initiated vancomycin therapy a mean of 5.4±8.9 days after confirmation of MRSA. Of the 70% of patients meeting criteria for IV-to-oral switch therapy, only 10% received oral treatment. The most common reason cited for not switching was lack of an effective oral alternative. Analysis of switch therapy criteria found that IV treatment continued for a mean of 13 days despite the appropriateness of the oral route.

CONCLUSIONS: Considerable variation exists in treatment patterns for MRSA infections. Improvements in the initiation of therapy and the use of IV-to-oral switch therapy may improve care and reduce the duration of hospitalization for MRSA SSTIs.