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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients involved, are included in bold type following each reference. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference
  1. Pallin DJ, Egan DJ, Pelletier AJ, et al. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med. 2008;51(3):291-298. (Retrospective analysis of surveillance data)
  2. Moran GJ, Krishnadasan A, Gorwitz RJ, et al; EMERGEncy ID Net Study Group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355(7):666-674. (Prospective observational; 422 patients)
  3. Chambers HF, Moellering RC Jr, Kamitsuka P. Clinical decisions: management of skin and soft-tissue infection. N Engl J Med. 2008;359(10):1063-1067. (Review)
  4. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41(10):1373-1406. (Consensus guideline)
  5. Gorwitz RJ, Jernigan DB, Powers JH, et al. Strategies for clinical management of MRSA in the community: summary of an experts' meeting convened by the Centers for Disease Control and Prevention. http://www.cdc.gov/ncidod/ dhqp/pdf/ar/CAMRSA_ExpMtgStrategies.pdf. Published March 2006. Accessed July 30, 2010. (Consensus guideline)
  6. Daum RS. Clinical practice: skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007;357(4):380-390. (Review)
  7. Abrahamian FM, Talan DA, Moran GJ. Management of skin and soft-tissue infections in the emergency department. Infect Dis Clin North Am. 2008;(1):89-116, vi. (Review)
  8. Swartz MN. Clinical practice: cellulitis. N Engl J Med. 2004;350(9):904-912. (Review)
  9. Wallin TR, Hern HG, Frazee BW. Community-associated methicillin-resistant Staphylococcus aureus. Emerg Med Clin North Am. 2008;26(2):431-455, ix. (Review)
  10. Nathwani D, Morgan M, Masterton RG, et al. Guidelines for UK practice for the diagnosis and management of methicillin- resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother. 2008;61(5):976- 994. (Consensus guideline)
  11. Gould FK, Brindle R, Chadwick PR, et al. Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. J Antimicrob Chemother. 2009;63(5):849-861. (Consensus guideline)
  12. Gemmell CG, Edwards DI, Fraise AP, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother. 2006;57(4):589-608. (Consensus guideline)
  13. Eron LJ, Lipsky BA, Low DE, et al. Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother. 2003;52(suppl 1):i3-i17. (Consensus guideline)
  14. DiNubile MJ, Lipsky BA. Complicated infections of skin and skin structures: when the infection is more than skin deep. J Antimicrob Chemother. 2004;53(suppl 2):ii37-ii50. (Review)
  15. US Food and Drug Administration. Guidance for industry: uncomplicated and complicated skin and skin structure infections—developing antimicrobial drugs for treatment. http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/ guidancees/ucm071185.pdf. Published July 1998. Accessed July 30, 2010. (FDA categorization guideline)
  16. Benner EJ, Kayser FH. Growing clinical significance of methicillin-resistant Staphylococcus aureus. Lancet. 1968;2(7571):741-744. (Review)
  17. Zetola N, Francis JS, Nuermberger EL, et al. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis. 2005;5(5):275-286. (Review)
  18. Crum NF, Lee RU, Thornton SA, et al. Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med. 2006;119(11):943-951. (Retrospective analysis of surveillance data)
  19. Frazee BW, Lynn J, Charlebois ED, et al. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med. 2005;45(3):311-320. (Prospective case study; 137 patients)
  20. Deresinski S. Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic odyssey. Clin Infect Dis. 2005;40(4):562-573. (Review)
  21. Bernard P, Bedane C, Mounier M, et al. Streptococcal cause of erysipelas and cellulitis in adults: a microbiologic study using a direct immunofluorescence technique. Arch Dermatol. 1989;125(6):779-782. (Prospective; 42 subjects)
  22. Herman RA, Kee VR, Moores KG, et al. Etiology and treatment of community-associated methicillin-resistant Staphylococcus aureus. Am J Health Syst Pharm. 2008;65(3):219-225. (Review)
  23. Carleton HA, Diep BA, Charlebois ED, et al. Communityadapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis. 2004;190(10):1730-1738. (Retrospective analysis of epidemiologic data; 490 samples)
  24. McDougal LK, Steward CD, Killgore GE, et al. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol. 2003;41(11):5113-5120. (Retrospective analysis; 957 isolates)
  25. King MD, Humphrey BJ, Wang YF, et al. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. 2006;144(5):309-317. (Prospective laboratory surveillance; 384 patients)
  26. Baba T, Takeuchi F, Kuroda M, et al. Genome and virulence determinants of high virulence community-acquired MRSA. Lancet. 2002;359(9320):1819-1827. (Genomic sequence analysis)
  27. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290(22):2976- 2984. (Prospective cohort; 1100 patients)
  28. Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton- Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet. 2002;359(9308):753-759. (Case series, 8 patients)
  29. Dietrich DW, Auld DB, Mermel LA. Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children. Pediatrics. 2004;113(4):e347-e352. (Retrospective chart review; 57 patients)
  30. Salgado CD, Farr BM, Calfee DP. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003;36(2):131- 139. (Meta-analysis)
  31. Adcock PM, Pastor P, Medley F, et al. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis. 1998;178(2):577-580. (Case series, 11 patients)
  32. Shahin R, Johnson IL, Jamieson F, et al. Methicillin-resistant Staphylococcus aureus carriage in a child care center following a case of disease. Arch Pediatr Adolesc Med. 1999;153(8):864- 868. (Case series/surveillance)
  33. Ellis MW, Hospenthal DR, Dooley DP, et al. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis. 2004;39(7):971-979. (Surveillance data)
  34. Aiello AE, Lowy FD, Wright LN, et al. Methicillin-resistant Staphylococcus aureus among US prisoners and military personnel: review and recommendations for future studies. Lancet Infect Dis. 2006;6(6):335-341. (Review)
  35. Kazakova SV, Hageman JC, Matava M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med. 2005;352(5):468-475. (Retrospective cohort; 84 subjects)
  36. Lee NE, Taylor MM, Bancroft E, et al. Risk factors for community- associated methicillin-resistant Staphylococcus aureus skin infections among HIV-positive men who have sex with men. Clin Infect Dis. 2005;40(10):1529-1534. (Matched casecontrol; 35 case patients and 76 control subjects)
  37. Young DM, Harris HW, Charlebois ED, et al. An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients. Arch Surg. 2004;139(9):947-951; discussion 951-953. (Retrospective analysis; 12,011 episodes of infection)
  38. Miller LG, Perdreau-Remington F, Bayer AS, et al. Clinical and epidemiologic characteristics cannot distinguish community- associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis. 2007;44(4):471-482. (Prospective observational; 280 patients)
  39. Kuo DC, Chasm RM, Witting MD. Emergency physician ability to predict methicillin-resistant Staphylococcus aureus skin and soft tissue infections. J Emerg Med. 2008;39(1):17-20. (Prospective observational; 176 patients)
  40. Centers for Disease Control and Prevention (CDC). Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections--Los Angeles County, California, 2002-2003. MMWR Morb Mortal Wkly Rep. 2003;52(5):88. (Surveillance data)
  41. Barrett TW, Moran GJ. Update on emerging infections: news from the Centers for Disease Control and Prevention: methicillin-resistant Staphylococcus aureus infections among competitive sports participants--Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. Ann Emerg Med. 2004;43(1):43-45; discussion 45-47. (Surveillance data)
  42. Moran GJ, Talan DA. MRSA community-acquired pneumonia: should we be worried? Ann Emerg Med. 2009;53(3):366- 368. (Editorial)
  43. Swanson DL, Vetter RS. Bites of brown recluse spiders and suspected necrotic arachnidism. N Engl J Med. 2005;352(7):700-707. (Review)
  44. Vetter RS, Swanson DL. Arthropods in dermatology: errors in arachnology. J Am Acad Dermatol. 2005;52(5):923. (Editorial)
  45. Carratala J, Rosón B, Fernández-Sabé N, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis. 2003;22(3):151-157. (Retrospective; 332 patients)
  46. Benfield T, Jensen JS, Nordestgaard BG. Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome. Diabetologia. 2007;50(3):549-554. (Retrospective; 1194 patients)
  47. Gorwitz RJ. A review of community-associated methicillinresistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J. 2008;27(1):1-7. (Review)
  48. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005;352(14):1436-1444. (Surveillance data; 1647 CA-MRSA cases)
  49. Lee MC, Rios AM, Aten MF, et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J. 2004;23(2):123-127. (Prospective observational; 69 patients)
  50. Ruhe JJ, Smith N, Bradsher RW, et al. Community-onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: impact of antimicrobial therapy on outcome. Clin Infect Dis. 2007;44(6):777-784. (Retrospective cohort; 492 patients)
  51. Szumowski JD, Cohen DE, Kanaya F, et al. Treatment and outcomes of infections by methicillin-resistant Staphylococcus aureus at an ambulatory clinic. Antimicrob Agents Chemother. 2007;51(2):423-428. (Retrospective chart review; 399 patients)
  52. Rajendran PM, Young D, Maurer T, et al. Randomized, double- blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother. 2007;51(11):4044- 4048. (Randomized double-blind placebo-controlled trial; 66 patients)
  53. Talan DA. MRSA: deadly super bug or just another staph? Ann Emerg Med. 2008;51(3):299-302. (Editorial)
  54. Miller LG, Quan C, Shay A, et al. A prospective investigation of outcomes after hospital discharge for endemic, community- acquired methicillin-resistant and -susceptible Staphylococcus aureus skin infection. Clin Infect Dis. 2007;44(4):483-492. (Prospective observational cohort; 117 patients)
  55. Klevens RM, Morrison MA, Nadle J, et al. Invasive methicillin- resistant Staphylococcus aureus infections in the United States. JAMA. 2007;298(15):1763-1771. (Population-based laboratory surveillance)
  56. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillinresistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352(14):1445-1453. (Retrospective; 14 patients)
  57. Gonzalez BE, Teruya J, Mahoney DH Jr, et al. Venous thrombosis associated with staphylococcal osteomyelitis in children. Pediatrics. 2006;117(5):1673-1679. (Retrospective; 9 patients)
  58. Pannaraj PS, Hulten KG, Gonzalez BE, et al. Infective pyomyositis and myositis in children in the era of community- acquired, methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis. 2006;43(8):953-960. (Retrospective; 45 patients)
  59. Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev. 2008;21(3):473-494. (Review)
  60. Adem PV, Montgomery CP, Husain AN, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children. N Engl J Med. 2005;353(12):1245-1251. (Case series; 3 patients)
  61. Kravitz GR, Dries DJ, Peterson ML, et al. Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis. 2005;40(7):941- 947. (Case series; 5 patients)
  62. Mongkolrattanothai K, Boyle S, Kahana MD, et al. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillinresistant isolates. Clin Infect Dis. 2003;37(8):1050-1058. (Case series; 4 patients)
  63. Wong CH, Khin LW, Heng KS, et al. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535-1541. (Retrospective observational cohort; 314 patients)
  64. Wong CH, Khin LW. Clinical relevance of the LRINEC (laboratory risk indicator for necrotizing fasciitis) score for assessment of early necrotizing fasciitis. Crit Care Med. 2005;33(7):1677. (Editorial)
  65. Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med. 2005;12(7):601-606. (Prospective; 107 patients)
  66. Tayal VS, Hasan N, Norton HJ, et al. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med. 2006;13(4):384-388. (Prospective observational; 126 patients)
  67. Abrahamian FM, Shroff SD. Use of routine wound cultures to evaluate cutaneous abscesses for community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med. 2007;50(1):66-67. (Editorial)
  68. Perl B, Gottehrer NP, Raveh D, et al. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis. 1999;29(6):1483-1488. (Retrospective; 757 patients)
  69. Gonzalez BE, Hulten KG, Dishop MK, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus infection. Clin Infect Dis. 2005;41(5):583- 590. (Retrospective; 160 patients)
  70. Centers for Disease Control and Prevention (CDC). Severe methicillin-resistant Staphylococcus aureus community-acquired pneumonia associated with influenza--Louisiana and Georgia, December 2006-January 2007. MMWR Morb Mortal Wkly Rep. 2007;56(14):325-329. (Surveillance data)
  71. Hageman JC, Uyeki TM, Francis JS, et al. Severe communityacquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis. 2006;12(6):894-899. (Surveillance data; 17 cases)
  72. Francis JS, Doherty MC, Lopatin U, et al. Severe community onset pneumonia in healthy adults caused by methicillinresistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis. 2005;40(1):100-107. (Case reports; 4 patients)
  73. Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics. 2008;122(4):805-811. (Surveillance data)
  74. Kallen AJ, Brunkard J, Moore Z, et al. Staphylococcus aureus community-acquired pneumonia during the 2006 to 2007 influenza season. Ann Emerg Med. 2009;53(3):358-365. (Population-based surveillance case reports)
  75. Kaka AS, Rueda AM, Shelburne SA III, et al. Bactericidal activity of orally available agents against methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 2006;58(3):680- 683. (Laboratory study of 12 MRSA strains)
  76. Adra M, Lawrence KR. Trimethoprim/sulfamethoxazole for treatment of severe Staphylococcus aureus infections. Ann Pharmacother. 2004;38(2):338-341. (Review)
  77. Iyer S, Jones DH. Community-acquired methicillin-resistant Staphylococcus aureus skin infection: a retrospective analysis of clinical presentation and treatment of a local outbreak. J Am Acad Dermatol. 2004;50(6):854-858. (Retrospective; 39 patients)
  78. Markowitz N, Quinn EL, Saravolatz LD. Trimethoprimsulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection. Ann Intern Med. 1992;117(5):390-398. (Randomized double-blind comparative; 101 patients)
  79. Treatment of community-associated MRSA infections. Med Lett Drugs Ther. 2006;48(1228):13-14. (Review)
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  82. Siberry GK, Tekle T, Carroll K, et al. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis. 2003;37(9):1257-1260. (Case report, 1 patient)
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  84. Panagea S, Perry JD, Gould FK. Should clindamycin be used as treatment of patients with infections caused by erythromycin- resistant staphylococci? J Antimicrob Chemother. 1999;44(4):581-582. (Editorial)
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  87. Centers for Disease Control and Prevention (CDC). Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005. MMWR Morb Mortal Wkly Rep. 2005;54(47):1201-1205. (Surveillance data)
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  90. Strausbaugh LJ, Jacobson C, Sewell DL, et al. Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans Affairs nursing home care unit. Infect Control Hosp Epidemiol. 1992;13(3):151- 159. (Prospective; 43 subjects)
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  104. Rajendran PM, Young DM, Maurer T, et al. Antibiotic use in the treatment of soft tissue abscesses: a survey of current practice. Surg Infect (Larchmt). 2007;8(2):237-238. (Survey of clinicians; 116 respondents)
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  113. Kalil AC, Puumala S, Stoner J. Is linezolid superior to vancomycin for complicated skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus? Antimicrob Agents Chemother. 2006;50(5):1910; author reply 1910-1911. (Editorial)
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  115. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39(7):885-910. (Consensus guideline)
  116. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of communityacquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27-S72. (Consensus guideline)
  117. Wunderink RG, Rello J, Cammarata SK, et al. Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest. 2003;124(5):1789-1797. (Retrospective analysis of data from two randomized trials; 1019 patients)
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  121. Boyce JM. MRSA patients: proven methods to treat colonization and infection. J Hosp Infect. 2001;48(suppl A):S9-S14. (Review)
  122. Simor AE, Daneman N. Staphylococcus aureus decolonization as a prevention strategy. Infect Dis Clin North Am. 2009;23(1):133-151. (Review)
  123. Simor AE, Phillips E, McGeer A, et al. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis. 2007;44(2):178-185. (Randomized comparison trial; 146 patients)
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Denise Nassisi

Publication Date

October 1, 2010

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