Purpose Describe the need for a revision to a treatment algorithm for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections 3 years after implementation. Methods Medical records for patients seen in the emergency department (ED) for CA-MRSA skin infections from October 2005 through August 2007 were compared with records for patients seen from September 2002 through September 2004. Results Most patients with CA-MRSA initially were seen in the ED; however, by mid-2007 an increasing number of patients were coming to primary care clinics, particularly with recurrent episodes, and treatment for CA-MRSA was suboptimal in this setting. In addition, approximately 14% of CA-MRSA cases were not considered high risk based on the algorithm risk assessment. When the algorithm was implemented, the risk assessment classified less than 5% of CA-MRSA cases as low risk. Furthermore, newly published data suggested that incision and drainage (I&D) was sufficient for small abscesses. Therefore, a revised algorithm that provided for treatment in all ambulatory settings, encouraged I&D for small abscesses, and facilitated empiric treatment for CA-MRSA in all cases of suspected staphylococcal infection was developed. Initial feedback from providers has been positive, and a post implementation review has been planned. Conclusion A treatment algorithm that initially facilitated the care of patients with CA-MRSA skin infections in the ED only required revision because changes in the epidemiology of this disease had been observed. The new algorithm provides for empiric treatment for CA-MRSA in all cases of suspected staphylococcal skin infection, regardless of perceived risk or setting.
289. International Validation of a Methicillin-Resistant Staphylococcus aureus (MRSA) Risk Assessment Tool for Acute Bacterial Skin and Skin Structure Infections (ABSSSI)