Rick Tosti1, Arianna Trionfo2, John Gaughan2, Asif M Ilyas2. 1. 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. 2. 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.
Abstract
PURPOSE: 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. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
PURPOSE: 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. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
Authors: Betsy Szeto; Fatos Kaba; Carolyn T A Herzig; Montina Befus; Franklin D Lowy; Benjamin A Miko; Zachary Rosner; Elaine L Larson Journal: Open Forum Infect Dis Date: 2017-08-03 Impact factor: 3.835
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