title: Risk factors associated with clindamycin-resistant, methicillin-resistant Staphylococcus aureus in hand abscesses.
abstract: OBJECTIVE
  To identify risk factors for clindamycin resistance in acute hand abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  METHODS
  We performed a retrospective review of 247 consecutive culture-positive hand abscesses from 2010 to 2012 at an urban hospital. Historical and laboratory data from patients with abscesses that grew MRSA with and without clindamycin resistance were compared in a multivariate analysis.
  
  
  RESULTS
  Methicillin-resistant Staphylococcus aureus grew on culture from 103 abscesses; 16% of those isolates were resistant to clindamycin. Multivariate analysis showed that younger age, intravenous drug use, and nosocomial acquired MRSA were significant risk factors for concurrent clindamycin resistance. Patients with a history of intravenous drug use and nosocomial acquired MRSA were, respectively, 11 and 5 times more likely to have concurrent clindamycin resistance. History of MRSA infection and human immunodeficiency virus were not identified as risk factors.
  
  
  CONCLUSIONS
  Patients with a history of intravenous drug use or recent contact with health care facilities appear to be a potential reservoir for emerging multidrug-resistant MRSA. Selection of clindamycin as an empiric antibiotic should be especially avoided for these groups.
  
  
  METHODS
  Prognostic III.
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA; Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA; Rothman Institute, Thomas Jefferson University, Philadelphia, PA. Electronic address: rtosti@temple.edu.
authors.forename: Rick
authors.initials: R
authors.lastname: Tosti
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA; Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA; Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Arianna
authors.initials: A
authors.lastname: Trionfo
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA; Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA; Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
authors.forename: John
authors.initials: J
authors.lastname: Gaughan
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA; Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA; Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000367:Age Factors; D000900:Anti-Bacterial Agents; D002981:Clindamycin / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D006225:Hand / Q000382:microbiology*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D015999:Multivariate Analysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin
keywords: MRSA; antibiotic resistance; clindamycin; hand infection