Staphylococcus aureus susceptibilities from wounds of patients who use illicit fentanyl.

OBJECTIVE

Develop a Staphylococcus aureus wound antibiogram among patients who use fentanyl (PWUF) presenting with acute S. aureus skin and soft tissue infections (SSTIs) in Philadelphia, Pennsylvania.

DESIGN

Retrospective, multisite cohort study.

PATIENTS AND

SETTING

Individuals presenting to emergency departments or admitted to inpatient units of four Penn Medicine hospitals with an acute S. aureus SSTI and illicit fentanyl use within the previous year.

METHODS

We described susceptibilities of S. aureus isolated from wound cultures among the PWUF cohort and compared these to the health system's wound antibiogram. We compared frequency of in-hospital medication treatment for opioid use disorder among patients who left the hospital prior to vs after the availability of S. aureus susceptibilities.

RESULTS

Among 131 S. aureus isolates from 131 PWUF, 35/131 (26.7%) were susceptible to oxacillin, 73/121 (60.3%) were susceptible to clindamycin, 77/122 (63.1%) were susceptible to tetracycline, and 119/126 (94.4%) were susceptible to trimethoprim-sulfamethoxazole. PWUF displayed significantly reduced susceptibility to oxacillin and tetracycline compared to the health system's outpatient wound S. aureus antibiogram. Compared to patients discharged prior to susceptibility availability, more patients discharged after the reporting of susceptibilities were administered buprenorphine or methadone in the hospital (82.0% vs 51.4%, P < 0.001).

CONCLUSION

High nonsusceptibility to clindamycin and tetracycline suggests these agents should not be prescribed as empiric therapy for acute S. aureus SSTI in PWUF in Philadelphia. PWUF would benefit from joint management by infectious diseases and addiction medicine experts to ensure prescription of active therapy. Additional study is needed of PWUF in other regions.