OBJECTIVES: Skin and soft tissue infection (SSTI) is a heterogeneous disease caused predominantly by Staphylococcus aureus and Gram-negative pathogens. The choice of anti-infective therapy varies depending on patterns of pathogen resistance, including prevalence of methicillin-resistant Staphylococcus aureus (MRSA). The objective of this study is to understand treatment patterns and outcomes in patients with SSTI in Belgium. METHODS: Data obtained from January - June 2004 Minimum Basic Data Set from 37 hospitals in Belgium, representing approximately 27% of total hospital beds, were used to identify patients hospitalized with SSTI using ICD-9 diagnostic codes and use of at least one intravenous antibiotic. Prescription claims were used to classify AI use into categories based on spectrum of activities, and were further divided into three categories: patients who received a broad spectrum agent and no anti-MRSA coverage (A), patients received a broad spectrum and later switch to (or add) anti-MRSA agent (B), and patients who received anti-MRSA and no broad spectrum agents (C). Anti-MRSA coverage classification was based on use of glycopeptides (vancomycin and teicoplanin). Costs are expressed in 2004 Euros RESULTS: A total of 607 patients were included in this study. The overall proportion of patients treated with anti-MRSA (groups B+C) was 16%. The number of co-diagnoses for groups A, B, and C were 13.5, 20.5, and 15.5, respectively. Mean (median) length of stay (LOS) was 29.4 (19.0), 42.2 (34.0) and 32.9 (24.5) for groups A, B, and C, respectively. Mortality rate was 13.3%, 30.2%, and 18.5% and median total costs were 8,423.00, 19,071.99 and 11,057.61 Euros, for groups A, B, and C, respectively. CONCLUSION: Patients who develop SSTI with MRSA are very costly. Early identification of patients at risk of SSTI involving MRSA and timely administration of appropriate AI therapy has significant implications on reducing costs and improving outcomes.