title: Community-acquired methicillin-resistant Staphylococcus aureus infections of the hand: prevalence and timeliness of treatment.
abstract: OBJECTIVE
  The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (ca-MRSA) appears to be increasing, but the timeliness of appropriate antibiotic delivery is often delayed. We retrospectively reviewed the prevalence of ca-MRSA infections in an urban setting, time from presentation to the hospital to appropriate antibiotic delivery, and differences in length of stay between the ca-MRSA and non-MRSA hand infections.
  
  
  METHODS
  We retrospectively reviewed all visits for hand infection cases to the emergency room of an urban academic medical center over a 12-month period. A formal hand infection algorithm was used in the treatment of each patient. All patients with culture-positive hand infections were included for evaluation. Infections determined to be nosocomial or not community-acquired were excluded. Patient demographics, laboratory studies, culture results, antibiotic delivery, and length of stay data were collected.
  
  
  RESULTS
  A total of 85 patients (55 male) with an average age of 39 years met the inclusion criteria. The overall prevalence rate of ca-MRSA hand infections was 55%. The average time to appropriate antibiotic delivery for ca-MRSA infection was 12 hours, versus 2.64 hours for non-MRSA hand infections (p > .5). The average length of stay was 4.0 days for ca-MRSA infections and 3.5 days for non-MRSA infections (p > .05). Univariate and multivariate analysis identified intravenous drug abuse and a serum white blood cell count of >8.7 as independent risk factors for ca-MRSA hand infections.
  
  
  CONCLUSIONS
  Community-acquired methicillin-resistant S. aureus infections of the hand continue to increase in urban settings. With the use of a formal hand infection treatment algorithm, we did not identify a statistical difference in appropriate antibiotic delivery time and length of stay between ca-MRSA and non-MRSA hand infections.
authors.affiliation: Temple Hand Center, Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA 19422, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Malley
authors.forename: John
authors.initials: J
authors.lastname: Fowler
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006225:Hand / Q000382:microbiology*; D006230:Hand Injuries / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015999:Multivariate Analysis; D015995:Prevalence; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology; D013997:Time Factors; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents