Impact of a Standardized Protocol to Address Methicillin-Resistant Staphylococcus aureus Skin Infections at a Large,Urban County Jail System

Abstract

Outbreaks of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have been reported in incarcerated populations nationwide. The authors compared MRSA infection rates before and after the implementation of a standardized treatment guideline in the San Diego County jail system. This guideline included mandatory culturing, personal and environmental hygiene measures, standardized antibiotic treatments based on sensitivity patterns, and close surveillance of cases. The guideline reduced the proportion of soft tissue infections caused by MRSA (90.3% to 57.8%) and decreased the proportion of inmates diagnosed with MRSA after 10 days in custody. Documented resolution of the infection improved from 30.7% to 68.7% of cases. The average number of different antibiotic regimens per patient decreased from 3.06 to 1.78. The authors conclude that the guideline resulted in a decrease in MRSA transmission, fewer antibiotic courses, and improved resolution of cases.

Keywords

MRSA jail health inmate health correctional health care

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References

Baba

, Takeuchi

, Kuroda

, Yuzawa

, Aoki

, Oguchi

, et al. (2002). Genome and virulence determinants of high virulence community-acquired MRSA. Lancet, 359, 1819-1827.

Centers for Disease Control and Prevention . (2001). Methicillin-resistant Staphylococcus aureus skin or soft tissue infections in a state prison—Mississippi, 2000. Morbidity and Mortality Weekly Report, 50, 919-922.

Centers for Disease Control and Prevention . (2003a). Methicillin-resistant Staphylococcus aureus infections in correctional facilities—Georgia, California, and Texas, 2001-2003. Morbidity and Mortality Weekly Report, 52, 992-996.

Centers for Disease Control and Prevention . (2003b). Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections—Los Angeles County, California, 2002-2003. Morbidity and Mortality Weekly Report, 52, 88-88.

Chambers, H. F. (2001). The changing epidemiology of Staphylococcus aureus? Emerging Infectious Diseases, 7, 178-182.

Enright, M. C. , Robinson, D. A. , Randle

, Feil, E. J. , Grundmann

, & Spratt, B. G. (2002). The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proceedings of the National Academy of Sciences of the United States of America, 99, 7687-7692.

Federal Bureau of Prisons . (2003, July). Clinical practice guidelines for the management of methicillin-resistant Staphylococcus aureus (MRSA) infections. Available from http://www.bop.gov/hsdgp/hsdcpgstaph.pdf (August 2005 version available from http://www.bop.gov/news/PDFs/mrsa.pdf)

Fey, P. D. , Said-Salim

, Rupp, M. E. , Hinrichs, S. H. , Boxrud, D. J. , Davis, C. C. , et al. (2003). Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrobial Agents and Chemotherapy, 47, 196-203.

Jones, J. H. (2002, December 7). Spider panic grips inmates. San Diego Union-Tribune, p. B1. Lowy, F. D. (1998). Staphylococcus aureus infections. New England Journal of Medicine, 339, 520-532.

10.

Pan, E. S. , Diep, B. A. , Carleton, H. A. , Charlebois, E. D. , Sensabaugh, G. F. , Haller, B. L. , et al. (2003). Increasing prevalence of methicillin-resistant Staphylococcus aureus infection in California jails. Clinical Infectious Diseases, 57, 1384-1388.

11.

Salgado, C. D. , Farr, B. M. , & Calfee, D. P. (2003). Community-acquired methicillin-resistant Staphylococcus aureus: A meta-analysis of prevalence and risk factors. Clinical Infectious Diseases, 36, 131-139.

12.

Samadi, R. R. , & Volturo, G. A. (2004). Bacterial skin and soft-tissue infections: A systemic approach to diagnosis and treatment. Emergency Medicine Reports, 25(13), 1-1.