When Meth Meets MRSA – Challenges in Treating Skin and Soft Tissue Infections

Authors:
Allison Berndtson, Jarrett Santorelli, John Austin, Katherine Chen, Laura Haines, Louis Perkins, Parisa Oviedo, Sadie Munter, Sarah Gierok

Body of Abstract:
Background
Skin and soft tissue infections (SSTIs) contribute to over 6 million emergency department (ED) visits annually, often requiring complex medical and surgical care. Methamphetamines are the second-most commonly used illicit substance in the U.S., with rising prevalence nationally and locally. This study aimed to identify clinical patterns and outcomes among SSTI patients with methamphetamine use to inform future care strategies. We hypothesized that methamphetamine users with SSTIs would require more surgical interventions and extended courses of broad-spectrum antibiotics when compared to non-users.
Methods
We performed a retrospective cohort study of patients presenting with SSTIs over three years who received a surgical consultation at our institution. Demographics (e.g., age, sex, race, housing status, Area Deprivation Index [ADI]), surgical interventions, antibiotic regimens, and culture data were analyzed. Methamphetamine use was determined by patient disclosure or urine toxicology. Broad-spectrum antibiotic use was defined as treatment with agents such as third-generation cephalosporins, carbapenems, or MRSA- and Pseudomonas-targeted therapies. Statistical analyses included t-tests for continuous variables and Fisher’s exact test for categorical variables.
Results
Among 321 clinical encounters, 299 were admitted and included in our analysis. Methamphetamine users were significantly younger, more often unhoused, and had higher ADI scores (all p < 0.005). They were also more likely to leave against medical advice (AMA) (p = 0.002). Broad-spectrum antibiotics were more commonly used across all patients (p < 0.005), and methicillin-resistant Staphylococcus aureus (MRSA) was the predominant pathogen in wound cultures. Methamphetamine users were more likely to grow aerobic species, while non-users had more anaerobic or facultative anaerobic pathogens (p < 0.005). No significant differences were observed in mortality, rates of surgical intervention, bacteremia, or polymicrobial infections. Conclusion Methamphetamine users with SSTIs present with unique clinical and microbiological challenges, including distinct wound flora and higher likelihood of AMA discharges. While they require similar rates of surgical intervention and broad-spectrum antibiotic therapy, managing these patients requires a tailored approach that accounts for their social determinants of health. These findings underscore the importance of integrating flexible, patient-centered strategies into SSTI care to address both medical and social complexities effectively.