9.0: Thursday, March 17, 2005

Changing Bacteriology of Soft Tissue Infections of the Upper Extremity

Wesley Schooler, MD and David M. Young, MD.

Introduction: Soft tissue upper extremity infections are a common problem encountered by plastic surgeons in the emergency room. The increase in community acquired strains of methicillin-resistant Staphylococcus Aureus (MRSA) complicates the management of these patients. The purpose of this study was to define the current bacteriology and antibiotic sensitivities of these infections.

Methods: All patients evaluated by plastic surgery service, with infections of the upper extremity were prospectively included in the study. Patients were managed by incision and drainage and intravenous or oral antibiotics.

Results: Forty-five patients with upper extremity soft tissue infections were entered over three months and 31 patients (68%) had cultures after incision and drainage. Locations of infection included digital infections in 20 patients (65%),hand (n=3), forearm (n=5), and upper arm (n=2). MRSA was the predominant organism in 26 patients (84%). The other common pathogen was group A Streptococcus (3%). MRSA strains were sensitive to vancomycin (100%), clindamycin (80%), trimethoprim/sulfamethoxazole (TMP/SXZ) (80%), and Ciprofloxacin (48%).

Conclusion: MRSA is the predominant organism in upper extremity soft tissue infections. Vancomycin is the intravenous antibiotic of choice but oral clindamycin and TMP/SXZ can also be used.