title: Increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus in hand infections at an urban medical center.
abstract: BACKGROUND
  The purpose of this article is to report the increased incidence of community-acquired methicillin-resistant S. aureus in hand infections at an urban medical center.
  
  
  METHODS
  The authors performed a retrospective review of all patients with hand infections over a 21-month period, and all patients with culture-positive methicillin-resistant S. aureus were identified. Cases determined to be nosocomial were excluded. The study period was divided into three 7-month periods.
  
  
  RESULTS
  A total of 343 hand infections were treated over a 21-month period. Eighty-nine patients (26 percent) with culture positive methicillin-resistant S. aureus were identified; of these, 75 were determined to be community-acquired methicillin-resistant S. aureus patients. Statistical analysis was performed using the Fisher's exact test (p < 0.0001), the chi-square test for equal proportions, the Cochran-Armitage trend test, and two-way analysis of variance. The demographics of the patients were compared using two-way analysis of variance, and patients were found to be similar in all three time periods with respect to mean age and sex. The incidence of community-acquired methicillin-resistant S. aureus increased to 40 percent during the last 7-month period compared with 14 percent during the first two periods. Overall, the incidence of methicillin-resistant S. aureus increased to 47 percent during the last 7 months compared with 16 percent and 17 percent in the first two 7-month periods, respectively. Based on their treatment approach and literature review, the authors have developed an algorithm to treat community-acquired methicillin-resistant S. aureus hand infections.
  
  
  CONCLUSIONS
  The authors' findings at Temple University Hospital may help to alert health care providers to take necessary steps to control the spread of methicillin-resistant S. aureus in the community and in the inpatient setting. Cultures should be carefully followed and infections should be treated with appropriate antibiotics.
authors.affiliation: Division of Plastic and Reconstructive Surgery and Hand Surgery, Temple University Hospital, USA.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Kiran
authors.forename: Beth
authors.initials: B
authors.lastname: McCampbell
authors.forename: Adam P
authors.initials: AP
authors.lastname: Angeles
authors.forename: Richard D
authors.initials: RD
authors.lastname: Montilla
authors.forename: Carlos
authors.initials: C
authors.lastname: Medina
authors.forename: Avir
authors.initials: A
authors.lastname: Mitra
authors.forename: John
authors.initials: J
authors.lastname: Gaughn
authors.forename: Julia
authors.initials: J
authors.lastname: Spears
authors.forename: Amit
authors.initials: A
authors.lastname: Mitra
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000465:Algorithms; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006225:Hand / Q000382:microbiology*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects; D014505:Urban Population