By Megan Brooks

NEW YORK (Reuters Health) - In doctors' offices in the U.S., skin infections have not become more common since the "superbug" MRSA began showing up in communities.

This finding contrasts with studies indicating that visits to U.S. emergency rooms and all non-hospital-inpatient medical settings for skin infections increased from 1993 to 2005, contemporaneously with the emergence of "community-associated MRSA."

"Taken together," Dr. Daniel J. Pallin noted in an email to Reuters Health, "we can conclude that the spread of community-associated MRSA has caused more people to become ill with skin infections, but only as observed from the perspective of the emergency department, not from the perspective of the physician's office."

"This is important," he added, "because substantially more visits occur in physicians' offices each year, relative to emergency departments."

Once largely seen only in hospitals, outbreaks of MRSA, which stands for methicillin-resistant Staphylococcus aureus, have occurred in recent years in community settings.

MRSA, which is resistant to most antibiotics, is responsible for an increasing number of skin infections among young children, prison inmates, military recruits and high school, college and professional football teams -- people who are in close contact and may share contaminated items.

Pallin, from Brigham and Women's Hospital, Boston, and colleagues used the National Ambulatory Medical Care Survey to analyze office visits between 1993 and 2005 that yielded a diagnosis of dermatitis or skin and soft tissue infection.

During the study period, dermatitis was diagnosed at 13 million office visits per year, and skin and soft tissue infection was diagnosed at 6.3 million office visits per year.

Importantly, the team notes, the frequency did not change for either diagnosis over time.

"Therefore," Pallin said, "this report can attenuate our collective fear of the 'superbug epidemic.'"

"Over the years," he continued, "we have also learned that this 'superbug' usually causes mild skin infections and is not a major cause of death and disability."

This contrasts with the older form of MRSA, which infects hospitalized patients, and is a major cause of illness and death "and a major focus of efforts to improve hospital hygiene, the researcher remarked.

SOURCE: Clinical Infectious Disease, September 1, 2009.

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