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Emergency physicians have long considered methicillin-resistant Staphylococcus aureus (MRSA) to be a hospital issue and generally don't take methicillin resistance into account when prescribing antibiotics for community-acquired skin infections. The authors of a retrospective study of S. aureus isolates from inmates in the San Francisco County jail system report a dramatic increase in MRSA skin infections in this population.
The proportion of methicillin-resistant isolates among all S. aureus isolates in the jail system increased from 29% in 1997 to 74% in 2002. Twelve percent of MRSA isolates (18 of 151) were multidrug-resistant. Rates of resistance to erythromycin and ciprofloxacin were high (64% and 72%, respectively).