I read with interest the two articles on community-acquired MRSA (CA-MRSA) infections in the April 2006 issue of BCMJ [48(3):114-120].
The SSTI management guidelines as suggested by Patrick, Henry, and Gamage (available at www.bccdc.org/content.php?item=194) are made especially relevant to current practice by their inclusion of community- acquired MRSA risk factor criteria. If this “broad emergence” of CA-MRSA is to be prevented from developing into an epidemic, then considered clinical decisions will have to precede susceptibility-focused treatment that is reliant on laboratory resources and timelines. However, both articles over look a crucial piece of the CA-MRSA story, at least as it exists in the Fraser Valley.
The literature on CA-MRSA cites several evidence-based risk factors for infection, including history of IVDU and homelessness, and these risk factors are explicitly referenced in the two articles. In Cimolai’s article, 7 of the 15 patients have drug use cited as a risk factor.
However, not all drug use is intravenous drug use. Indeed, the most worrisome aspect of the CA-MRSA presence in my own clinical experience in Chilliwack is its strong association with crystal meth drug abuse. Use of this drug is not restricted to IVDU or homeless, incarcerated, or Aboriginal populations, and it is rising exponentially in many different communities and populations within society at large.
The symbiotic nature of these two emerging public health issues has the potential for a true “perfect storm” scenario.
|—||Mark MacKenzie MD,
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