title: Evolving incidence of MRSA in urban hand infections.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly cultured bacteria in hand infections. Understanding the most common bacteria involved in hand infections allows appropriate and efficient administration of antibiotics. Delay in treatment may lead to increased morbidity, including stiffness, contracture, and amputation. The purposes of this study are to determine whether the incidence of MRSA in culture-positive hand infections continues to increase and whether MRSA is a risk factor for increased length of stay. Electronic medical records were queried to identify patients admitted to a large, academic urban medical center with the diagnosis of a hand infection between January 1, 2005, and December 31, 2009. Methicillin-resistant S aureus accounted for 220 of the positive cultures over the 5-year study period. Polymicrobial infection represented 81 positive cultures, and MRSA was only present in 10 of these cases. Patients with MRSA were found to have a mean length of hospital stay of 4.1 days compared with 4.5 days in non-MRSA infections. Understanding the most common bacteria involved in hand infections allows appropriate and efficient administration of antibiotics. Methicillin-resistant S aureus is the most commonly cultured bacteria in the hand. However, polymicrobial infections have become increasingly more common. Although incidences of polymicrobial infections increased over the study period in this series, clinical judgment should be exercised before initiating broad-spectrum antibiotic coverage.
authors.affiliation: Department of Orthopedics, University of Pittsburgh, Ste 911, Kaufmann Bldg, 3471 Fifth Ave, Pittsburgh, PA 15213, USA. johnfowler10@gmail.com
authors.forename: John R
authors.initials: JR
authors.lastname: Fowler
authors.forename: Dustin
authors.initials: D
authors.lastname: Greenhill
authors.forename: Alyssa A
authors.initials: AA
authors.lastname: Schaffer
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Thoder
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006229:Hand Dermatoses / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D055815:Young Adult