Introduction

Volume 14 - Issue 12 - December 2001
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Faculty & CME Reviewers

Faculty

Lena M. Napolitano, MD, FACS, FCCP, FCCM - Chair
Professor of Surgery
Chief, Surgical Critical Care
Associate Chair for Critical Care
Department of Surgery
University of Michigan Medical Center
Ann Arbor, Michigan

Kamal M.F. Itani, MD, FACS
Professor of Surgery
Boston University School of Medicine
Chief of Surgery
Boston Veterans Administration Health Care System
Associate Chief of Surgery
Boston University and Brigham and
Women’s Hospitals
West Roxbury, Massachusetts

Dennis L. Stevens, MD, PhD
Professor of Medicine
University of Washington School of Medicine
Seattle, Washington
Staff Physician and Chief, Infectious
Diseases Section
Associate Chief of Staff, Research and
Development Service
Veterans Affairs Medical Center
Boise, Idaho

CME Reviewers

Richard A. Proctor, MD
Professor, Medicine, Microbiology and Immunology
Professor, Department of Medicine
University of Wisconsin School of Medicine
and Public Health
Madison, Wisconsin

Andrew W. Urban, MD
Clinical Associate Professor of Medicine,
Section of Infectious Diseases
University of Wisconsin School of Medicine and Public Health
Chief, Infectious Disease
William S. Middleton Memorial Veterans Hospital
Madison, Wisconsin

The burden of infections in surgical patients today is alarming. In the United States, Staphylococcus aureus is the most common cause of skin and soft tissue infections (SSTIs). Approximately 70% of nosocomial infections are due to gram-positive organisms, with methicillin-resistant S. aureus (MRSA) being a very common nosocomial pathogen in hospitalized patients and the most common nosocomial pathogen in surgical patients. Equally alarming is the recent, rapidly rising occurrence of community-acquired MRSA (CA-MRSA), a pathogen that appears to have evolved independently of healthcare-associated MRSA (HA-MRSA).

While vancomycin has been a workhorse antibiotic for the treatment of gram-positive infections over the last 30 years, there is mounting evidence that the susceptibility of MRSA to vancomycin is slowly changing, and, in fact, total resistance to vancomycin has been described.

These articles will discuss complicated SSTIs (cSSTIs), including diabetic foot infections and surgical site infections, and the changing epidemiology of these infections. The impact of MRSA on patient outcome in these infections will also be discussed. The differences between CA-MRSA and HA-MRSA infections, and the antimicrobial therapies for these infections will be reviewed.

The objectives of this supplement are for clinicians to recognize the threat of HA-MRSA and CA-MRSA in the surgical setting and implement strategies to minimize this threat; to differentiate infections due to HA-MRSA versus those due to CA-MRSA; and to evaluate the utility of anti-MRSA agents for empiric and directed therapy in patients with HA-MRSA and CA-MRSA.