A high prevalence of antibiotic use and skin and soft tissue infections (SSTI) caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) were identified in remote and isolated Indigenous communities across Canada, according to data from a retrospective chart review study published in BMC Infectious Diseases.
Investigators conducted the review at nursing stations in 12 First Nations communities across the 5 provinces in Canada. Charts were randomly selected from nursing stations, and 372 patients who had accessed care in the previous 12 months and were ≥18 years old were included.
Of the 372 patients reviewed, 60.2% had >1 antibiotic prescription in the previous 12 months, and 569 prescriptions (for 224 patients) were written in total. Of these 224 patients, 86 (38.39%) received a prescription for the treatment of SSTI. Results demonstrated that 27 (31.40%) patients had >1 SSTI in the past 12 months.
Further, 33.58% of patients who received a diagnosis of SSTI received any diagnostic testing. In cases wherein wound culture and antimicrobial susceptibility results were available, 29% of MRSA isolates showed susceptible erythromycin vs 90.5% and 95.2% that were susceptible to clindamycin and cotrimoxazole, respectively.
Participation in the study was voluntary, meaning communities with higher SSTI and CA-MRSA rates were possibly more or less likely to volunteer, limiting the generalizability of the findings. It was also not possible to comment on uptake or adherence introducing bias, as antibiotic use patterns were defined by prescription only. Further, the blinding of reviewers was not possible, but the study authors had no previous interactions with the patients or staff at nursing stations. The investigators noted that the availability of data was limited because of the retrospective nature of the study, which may have biased results. Patient charts also lacked important social and environmental risk factors, and logistical factors prevented the ratio of sampled charts to completely meet the designed sampling ratio.
The results demonstrated a high prevalence of antibiotic use in these remote and isolated communities, with many residents seeking care for SSTIs, 40% of which were attributable to CA-MRSA. According to investigators, “in addition to appropriate and timely medical treatment, a comprehensive approach to infection control and prevention is needed to ensure that First Nations living in remote and isolated communities achieve equitable healthcare services.”
Jeong D, Nguyen HNT, Tyndall M, Schreiber YS. Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections. BMC Infect Dis. 2020;20:118.