title: Epidemiology of adult acute hand infections at an urban medical center.
abstract: OBJECTIVE
  To define the current epidemiology of adult acute hand infections in an urban setting, with the aim of helping to improve empiric treatment, as hand infections represent a major source of morbidity and can result in stiffness and, possibly, amputation.
  
  
  METHODS
  We performed an electronic medical record search to identify all patients admitted to our urban academic medical center with diagnoses related to open wounds and infections in the hand and fingers over a 6-year period (2005-2010). We recorded demographic data, location of infection, medical comorbidities, and culture data.
  
  
  RESULTS
  Of the 2,287 patients admitted with diagnoses related to open wounds and infections in the hand and fingers, 1,507 incision and drainage procedures were performed, which resulted in 458 patients (30%) with culture-positive infections. Wound cultures identified 39 different species of bacteria. Most of these were methicillin-resistant Staphylococcus aureus, which compromised 53% of positive cultures, followed by methicillin-sensitive S aureus in 23% of positive cultures. The cultures were polymicrobial in 19%. History of intravenous drug use or diabetes mellitus was a strong predictor of polymicrobial infection.
  
  
  CONCLUSIONS
  Methicillin-resistant Staphylococcus aureus was the most common bacteria cultured from these infections. Empiric antibiotic coverage should routinely cover methicillin-resistant S aureus. We noted a higher incidence of polymicrobial infections than previously reported, particularly with intravenous drug use, diabetes, and human bites. Volar hand infections had the highest percentage of positive cultures, whereas paronychia had the lowest percentage.
  
  
  METHODS
  Prognostic IV.
authors: Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA; and the Rothman Institute; Philadelphia, PA 15213, USA. johnfowler10@gmail.com
authors: John R
authors: JR
authors: Fowler
authors: Asif M
authors: AM
authors: Ilyas
mesh_terms: D000046:Academic Medical Centers; D001424:Bacterial Infections / Q000453:epidemiology*; D060085:Coinfection / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004073:Digitoxigenin / Q000031:analogs & derivatives; D006225:Hand / Q000382:microbiology*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D010304:Paronychia / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D013203:Staphylococcal Infections; D014505:Urban Population
chemical_list: C504216:INCICH-D7; D004073:Digitoxigenin