9.0: Thursday, March 17, 2005

Increasing Incidence of MRSA in Hand Infections: A Three Year County Hospital Experience

Danielle M. Le Blanc, MD, Edward M. Reece, MD, and Jeffrey E. Janis, MD.

Background. Methicillin-resistant Staphylococcus aureus (MRSA) and community-acquired MRSA (CA-MRSA) have increased in prevalence, with overall rates near 50% at our institution in 2002. The object of this study was to determine the incidence of MRSA with respect to hand infections, the antibiotic resistance pattern of MRSA, and implications for a change in antibiotic treatment algorithms.

Methods. A retrospective chart review of 752 patients with hand infections tracked by ICD-9 codes for finger or hand abscesses from 2001-2003 at Parkland Memorial Hospital. Culture results from 436 patients were analyzed for type of organism, and sensitivity profiles were obtained for all MRSA isolates.

Results. Median age of patients=40(16-77), 71% males, 28% females. Of 436 cultures reviewed, 371(85%) had organisms identified. MRSA isolates accounted for 78% of all staphylococcus species cultured, and 57% of all bacteria cultured from hand infections in 2003. MRSA isolates were 86% sensitive to conventional antibiotics.

Conclusion. MRSA accounted for nearly 60% of simple hand infections at our institution in 2003, with an increasing trend of resistance patterns among conventional antibiotics. The treatment algorithm at Parkland Hospital now includes abscess drainage and culture accompanied by an antibiotic regimen targeted specifically at MRSA.