Incidence and treatment of methicillin-resistant Staphylococcus aureus in hand infections presenting in an urban setting

Document Type

Journal Article

Publication Date

3-1-2012

Journal

Current Orthopaedic Practice

Volume

23

Issue

2

DOI

10.1097/BCO.0b013e318244dc2f

Keywords

Antibiotic resistance; Community-acquired; Hand infections; Methicilllin-resistant staphylococcus aureus; Prevalence

Abstract

Background Until the early 1990s, there was a paucity of literature on methicillin-resistant Staphylococcus aureus (MRSA) hand infections. More recently, much has been published on the incidence of both nosocomial and community-acquired MRSA (CA-MRSA) hand infections. The purpose of this study was to retrospectively determine the incidence of CA-MRSA hand infections and to report the susceptibility of the organism to four commonly used antibiotics. Methods Between 2003 and 2008, 77 patients were included. All patients underwent surgical debridement and were later admitted to the orthopaedic service. Cultures were obtained in a sterile fashion from spontaneous drainage or from incision and drainage sites. Organism identification and antibiotic susceptibility were reviewed. Patients not meeting the community-acquired definition were excluded. Results Seventy-two cases of community-acquired hand infections were analyzed. Fifty-nine percent of the patients were MRSA positive. All MRSA infections were susceptible to vancomycin, 95% were susceptible to clindamycin, and none were susceptible to cefazolin. Although the sensitivity to trimethoprim/sulfamethoxazole (TMP-SMX) was available in only 11 of the MRSA isolates, all were noted to be sensitive. Conclusions The rate of CA-MRSA hand infections remains high; we report a 59% incidence. Although surgical drainage often is performed, there is no consensus regarding optimal antimicrobial treatment. Sensitivities to vancomycin and TMP-SMX are well reported, but sensitivity to clindamycin is not. We report a 95% sensitivity to clindamycin, but further clinical studies are needed to understand the optimal treatment of MRSA hand infections. © 2012 Wolters Kluwer Health.

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