Persons experiencing homelessness (PEH) are more likely to have first-line antibiotic coverage for methicillin-resistant Staphylococcus aureus (MRSA), although the odds of group A Streptococcus (GAS) skin and soft tissue infections (SSTIs) are significantly higher among PEH, according to a research letter published online Feb. 9 in JAMA Dermatology .

Adam Zakaria, from the University of California San Francisco School of Medicine, and colleagues examined the association between homelessness and GAS SSTIs in a retrospective cross-sectional analysis of inpatients between March 2018 and March 2020. Overall, 181 patients with SSTIs with microbiology data were included in the analysis.

The researchers found that the rates of ecthyma (21 versus 3 percent) and ectoparasitic disease (8 versus 0.8 percent) were significantly higher for PEH. At the time of dermatology consultation, significantly higher rates of first-line MRSA coverage (91 versus 70 percent) and nonsignificantly reduced rates of first-line GAS coverage (30 versus 47 percent) were seen for PEH. Overall, 42 and 33 percent of PEH had GAS-positive cultures and MRSA-positive cultures, respectively; among those with stable housing, the corresponding proportions were 15 and 23 percent. After adjustment for confounding variables, the odds of GAS SSTI were significantly higher for PEH relative to those with stable housing (odds ratio, 4.25) and the odds of MRSA SSTI were nonsignificantly higher (odds ratio, 1.49).

"Future studies are needed to demonstrate causation, establish a more precise effect size estimate, and evaluate outcomes among PEH receiving empirical GAS coverage for SSTI," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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