Community acquired methicillin resistant Staphylococcus aureus hand infections: a South Pacific perspective - characteristics and implications for antibiotic coverage.
OBJECTIVE
Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections are reported to be increasing worldwide. In the United States when rates exceed 15% empiric treatment is suggested. The aim of our study was to determine local rates and treatment of CA-MRSA within our region.


METHODS
Nine hundred and forty-two patients were admitted to our service during a six-year period with culture-positive hand infections identified from operative cultures at the time of surgery.


RESULTS
Sixty-six (7.0%) patients had CA-MRSA positive cultures identified. Thirty-two (48.5%) patients were noted to have remained on antibiotic treatment that did not reflect their MRSA positive status after cultures returned. Despite this, re-admission and re-operation rates were low and comparable to our non-MRSA control group.


CONCLUSIONS
Within our CA-MRSA group, current rates do not support automatic empiric treatment for CA-MRSA. Based on sensitivity data, co-trimoxazole and intravenous vancomycin are appropriate and effective antibiotic treatment within our region. Our data supports the importance of drainage of pyogenic infections in helping to resolve complicated hand infections.
Auckland Regional Plastic, Reconstructive and Hand Surgery Unit, Middlemore Hospital,  New Zealand.
Derek
D
Buchanan
Wolfgang
W
Heiss-Dunlop
Jon A
JA
Mathy
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D015994:Incidence; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D009520:New Zealand / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
D000900:Anti-Bacterial Agents