title: Community-acquired methicillin-resistant Staphylococcus aureus hand infections in the pediatric population.
abstract: OBJECTIVE
  Recent studies have reported rates of methicillin-resistant Staphylococcus aureus (MRSA) hand infections in patients without risk factors ranging from 26% to 73%. The purpose of our study was to review a large series of pediatric hand infections to determine the rate of MRSA and identify potential risk factors.
  
  
  METHODS
  A retrospective review was performed on patients younger than 15 who were seen for hand infections (2001-2010). Patients were categorized according to medical problems, need for operation, abscess location, and mechanism of injury. Potential MRSA risk factors were assessed using a multivariate-regression model.
  
  
  RESULTS
  During the 10-year period, 415 patients were seen for hand infections. A total of 146 patients met the inclusion criteria: patients younger than 15 years of age who presented to the plastic surgery service requiring consultation for hand infections. The overall prevalence of MRSA-positive cultures was found to be 30%. The prevalence of MRSA was 29% in healthy patients and 0% in immunocompromised patients. The prevalence of MRSA increased in a linear fashion from patients without documentation of incision and drainage procedures to patients adequately treated with bedside incision and drainage to patients who required surgical drainage. There was a trend toward a higher prevalence of MRSA in deep space abscesses compared to other abscesses. Patients with a history of trauma and previous MRSA infections had a higher rate of MRSA than other patients.
  
  
  CONCLUSIONS
  Traditionally, MRSA has been associated with hospitalization, intravenous drug use, recent antibiotic use, and compromised immunity. In our study, more severe, deep-space abscesses requiring surgical drainage and patients with a history of previous MRSA infections were found to have a higher prevalence of MRSA. The immunocompromised patients had no cases of MRSA and had higher incidences of less virulent bacterial infections. This suggests that acquisition of community-acquired MRSA skin and soft tissue infections in children and adolescents might not be associated with the traditional risk factors.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Michael Thomas
authors.initials: MT
authors.lastname: Chung
authors.forename: Patrick
authors.initials: P
authors.lastname: Wilson
authors.forename: Brian
authors.initials: B
authors.lastname: Rinker
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006225:Hand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology*