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Inadequate Postgraduate Training of Skin and Soft Tissue Infections in an Era of Community-Associated Methicillin-Resistant Staphylococcus aureus
  1. Chad S. Kessler, MD*†,
  2. Khadidjatou Kane, MD,
  3. Sharmistha Dev, MD, MPH,
  4. Jeremy L. Smiley, MD
  1. From the *Durham VA Medical Center, Durham, NC; †Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL; and ‡Northwestern University Feinberg School of Medicine, Chicago, IL.
  1. Received February 17, 2013, and in revised form March 24, 2013.
  2. Accepted for publication March 27, 2013.
  3. Reprints: Chad S. Kessler, Durham VA Medical Center, 508 Fulton St, Durham, NC 27705. E-mail: chad.kessler{at}
  4. The manuscript, as submitted or its essence in another version, is not under consideration for publication elsewhere, and will not be published elsewhere while under consideration by the Journal of Investigative Medicine. The authors have no commercial associations or sources of support that might pose a conflict of interest. All authors have made substantive contributions to the study, and all authors endorse the data and conclusions.


Background Since 2002, the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) has been steadily increasing and CA-MRSA may now account for most community-based SSTIs. Although consensus remains vague, using antibiotics with MRSA coverage has shown improved rates of clinical resolution. The goal of this pilot study was to assess resident physicians’ awareness and management of CA-MRSA SSTIs in the acute/ambulatory care setting.

Methods This is a prospective cross-sectional survey-design study based on clinical case scenarios approved by the university’s institutional review board. The survey was distributed to residents in internal medicine, general surgery, and emergency medicine. The survey was designed to assess (1) their knowledge of MRSA prevalence in community SSTIs and (2) their choice of empiric antibiotic for community-based SSTIs.

Results Across all residency programs, only 15.7% of residents correctly estimated prevalence of CA-MRSA in SSTIs in the acute care/ambulatory setting to be 50% or higher. In practice, 28.6% of general surgery residents, 50.0% of internal medicine residents, and 69.7% of emergency medicine residents would use an antibiotic with appropriate MRSA coverage.

Conclusion This pilot study reveals that a substantial number of resident physicians are unaware of the increasing prevalence of CA-MRSA SSTIs and continue to use β-lactam antibiotics for empiric pharmacotherapy of community-based SSTIs. More education is desperately needed on this crucial topic across various residency training programs.

Key Words
  • MRSA
  • soft tissue infections
  • resident education

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