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.

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