Community-acquired methicillin-resistant Staphylococcus aureus infections of the hand: prevalence and timeliness of treatment.

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.