Purpose
The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (ca-MRSA) appears to be increasing, but the timeliness of appropriate antibiotic
delivery is often delayed. We retrospectively reviewed the prevalence of ca-MRSA infections
in an urban setting, time from presentation to the hospital to appropriate antibiotic
delivery, and differences in length of stay between the ca-MRSA and non-MRSA hand
infections.
Methods
We retrospectively reviewed all visits for hand infection cases to the emergency room
of an urban academic medical center over a 12-month period. A formal hand infection
algorithm was used in the treatment of each patient. All patients with culture-positive
hand infections were included for evaluation. Infections determined to be nosocomial
or not community-acquired were excluded. Patient demographics, laboratory studies,
culture results, antibiotic delivery, and length of stay data were collected.
Results
A total of 85 patients (55 male) with an average age of 39 years met the inclusion
criteria. The overall prevalence rate of ca-MRSA hand infections was 55%. The average
time to appropriate antibiotic delivery for ca-MRSA infection was 12 hours, versus
2.64 hours for non-MRSA hand infections (p > .5). The average length of stay was 4.0
days for ca-MRSA infections and 3.5 days for non-MRSA infections (p > .05). Univariate
and multivariate analysis identified intravenous drug abuse and a serum white blood
cell count of >8.7 as independent risk factors for ca-MRSA hand infections.
Conclusions
Community-acquired methicillin-resistant S. aureus infections of the hand continue to increase in urban settings. With the use of a
formal hand infection treatment algorithm, we did not identify a statistical difference
in appropriate antibiotic delivery time and length of stay between ca-MRSA and non-MRSA
hand infections.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Accepted:
November 19,
2008
Received:
May 30,
2008
Footnotes
The authors thank John Gaughan, PhD, for assistance in performing the statistical analysis of the data.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 Published by Elsevier Inc.
