title: Does empiric antibiotic therapy change MRSA [corrected] hand infection outcomes? Cost analysis of a randomized prospective trial in a county hospital.
abstract: BACKGROUND
  The incidence of community-acquired methicillin-resistant Staphylococcus aureus infections is rising at an alarming pace. Effective treatment has historically involved early débridement and antibiotic administration. This study was designed to prospectively determine the effectiveness of empiric therapy in treating hand infections.
  
  
  METHODS
  A prospective randomized trial was conducted at a level I county hospital. Patients with a hand infection received either empiric intravenous vancomycin at admission or intravenous cefazolin. Outcomes were tracked using severity of infection, appropriate clinical response, and length of stay. Cost-effectiveness was calculated using total cost for each patient in both groups. Statistical analyses were performed.
  
  
  RESULTS
  Forty-six patients were enrolled in the study. Twenty-four were randomized to cefazolin (52.2 percent) and 22 (47.8 percent) to vancomycin. There was no statistical difference between cost of treatment (p < 0.20) or mean length of stay (p < 0.18) between the groups. Patients randomized to cefazolin had higher mean costs of treatment compared with patients who were randomized to vancomycin (p < 0.05). Patients with more severe infections had more expensive mean costs of treatment (p < 0.0001) and longer mean length of stay (p = 0.0002). Near the end of the study, the incidence of community-acquired methicillin-resistant S. aureus at the authors' county hospital was discovered to be 72 percent, which caused the study to be terminated prematurely by the institutional review board because of the high incidence precluding further randomization.
  
  
  CONCLUSIONS
  Appropriate early treatment for methicillin-resistant S. aureus has not been definitively established. No difference in outcome using cefazolin versus vancomycin as a first-line agent was identified.
authors.affiliation: Columbus, Ohio; Houston and Dallas, Texas; and Phoenix, Ariz. From the Department of Plastic Surgery, The Ohio State University Medical Center; the Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine; the Arizona Center for Hand Surgery; and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Janis
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hatef
authors.forename: Edward M
authors.initials: EM
authors.lastname: Reece
authors.forename: Corrine
authors.initials: C
authors.lastname: Wong
mesh_terms: D000038:Abscess / Q000188:drug therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D002437:Cefazolin / Q000008:administration & dosage* / Q000191:economics; D017714:Community-Acquired Infections; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006225:Hand / Q000382:microbiology*; D017721:Hospital Costs; D006766:Hospitals, County; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D014640:Vancomycin / Q000008:administration & dosage* / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002437:Cefazolin