28. MRSA INCIDENCE AND ANTIBIOTIC TRENDS IN HAND INFECTIONS: A 05-YEAR LONGITUDINAL STUDY IN HOSPITAL FOR TRAUMA AND ORTHOPEADIC
Main Article Content
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most reported pathogen in hand infections at medical centers throughout the world. Antibiotic sensitivity trends are not well known. The purposes of this study were to examine and determine the drug resistance trends for MRSA infections of the hand and to provide recommendations for empiric antibiotic treatment based on sensitivity profiles
Objectives: A 05-year longitudinal, retrospective review was performed on all culture-positive hand infections encountered in HTO from 2019 to 2023. The proportions of all organisms were calculated for each year and collectively. MRSA infections were additionally subanalyzed for antibiotic sensitivity
Results: A total of 369 culture-positive hand infections were identified. Overall, MRSA grew on culture in 38% of cases. A trend toward decreasing annual MRSA incidence was noted over the 05-year study period. There was a steady increase in polymicrobial infections during the same time. Resistance to clindamycin increased steadily during the 05-year study, starting at 53.85% in 2021 but growing to 78.26% by 2023. Similarly, levofloxacin resistance consistently increased throughout the study, reaching its peak at 60.71% in 2019 ; however, decreasing at 29.17% in 2023
Conclusions: The annual incidence of MRSA in hand infections remains the most common pathogen. There has been an alternative increase in the number of polymicrobial infections. MRSA resistance to clindamycin and levofloxacin consistently increased during the study period. Empiric antibiotic therapy for hand infections should not only avoid penicillin and other beta-lactams but should also consider avoiding clindamycin and levofloxacin for empiric treatment.
Article Details
Keywords
Hand infection, MRSA, antibiotic resistance, polymicrobial, hand abscess.
References
Plastic and reconstructive surgery. Oct
2009;124(4):225e-233e. doi:10.1097/
PRS.0b013e3181b458c9
[2] Bach HG, Steffin B, Chhadia AM et al.,
Community-associated methicillin-resistant
Staphylococcus aureus hand infections in an
urban setting. The Journal of hand surgery.
Mar 2007;32(3):380-3. doi:10.1016/j.
jhsa.2007.01.006
[3] Fowler JR, Ilyas AM, Epidemiology of adult acute
hand infections at an urban medical center. The
Journal of hand surgery. Jun 2013;38(6):1189-
93. doi:10.1016/j.jhsa.2013.03.013
[4] Houshian S, Seyedipour S, Wedderkopp N,
Epidemiology of bacterial hand infections.
International journal of infectious diseases: IJID:
official publication of the International Society
for Infectious Diseases. Jul 2006;10(4):315-9.
doi:10.1016/j.ijid.2005.06.009
[5] Kowalski TJ, Thompson LA, Gundrum
JD, Antimicrobial management of septic
arthritis of the hand and wrist. Infection. Apr
2014;42(2):379-84. doi:10.1007/s15010-013-
0566-0
[6] O’Malley M, Fowler J, Ilyas AM, Communityacquired
methicillin-resistant Staphylococcus
aureus infections of the hand: prevalence and
timeliness of treatment. The Journal of hand
surgery; Mar 2009;34(3):504-8. doi:10.1016/j.
jhsa.2008.11.021
[7] Osterman M, Draeger R, Stern P, Acute hand
infections. The Journal of hand surgery; Aug
2014;39(8):1628-35; quiz 1635. doi:10.1016/j.
jhsa.2014.03.031
[8] Tosti R, Samuelsen BT, Bender S et al.,230
Emerging multidrug resistance of methicillinresistant
Staphylococcus aureus in hand
infections. The Journal of bone and joint surgery
American volume; Sep 17 2014;96(18):1535-40.
doi:10.2106/jbjs.M.01159
[9] Tosti R, Trionfo A, Gaughan J et al., Risk
factors associated with clindamycin-resistant,
methicillin-resistant Staphylococcus aureus
in hand abscesses. The Journal of hand
surgery; Apr 2015;40(4):673-6. doi:10.1016/j.
jhsa.2014.12.044
[10] Fowler JR, Greenhill D, Schaffer AA et al.,
Evolving incidence of MRSA in urban hand
infections. Orthopedics; Jun 2013;36(6):796-
800. doi:10.3928/01477447-20130523-27
[11] Lodise TP, McKinnon PS, Burden of
methicillin-resistant Staphylococcus aureus:
focus on clinical and economic outcomes.
Pharmacotherapy; Jul 2007;27(7):1001-12.
doi:10.1592/phco.27.7.1001
[12] Shorr AF, Epidemiology and economic
impact of meticillin-resistant Staphylococcus
aureus: review and analysis of the literature.
PharmacoEconomics; 2007;25(9):751-68.
doi:10.2165/00019053-200725090-00004
[13] Gorwitz RJ, Jernigan DB, Jernigan JA,
Strategies for clinical management of MRSA in
the community; summary of an experts’ meeting
convened by the Centers for Disease Control and
Prevention, 2006.
[14] Wilson PC, Rinker B, The incidence of
methicillin-resistant staphylococcus aureus in
community-acquired hand infections. Annals
of plastic surgery; May 2009;62(5):513-6.
doi:10.1097/SAP.0b013e31818a6665
[15] Gorwitz RJ, A review of community-associated
methicillin-resistant Staphylococcus aureus
skin and soft tissue infections. The Pediatric
infectious disease journal; Jan 2008;27(1):1-7.
doi:10.1097/INF.0b013e31815819bb
[16] Rodvold KA, McConeghy KW, Methicillinresistant
Staphylococcus aureus therapy: past,
present, and future. Clinical infectious diseases :
an official publication of the Infectious Diseases
Society of America; Jan 2014;58 Suppl 1:S20-7.
doi:10.1093/cid/cit614
[17] MacDougall C, Powell JP, Johnson CK et al.,
Hospital and community fluoroquinolone use
and resistance in Staphylococcus aureus and
Escherichia coli in 17 US hospitals. Clinical
infectious diseases : an official publication of the
Infectious Diseases Society of America; Aug 15
2005;41(4):435-40. doi:10.1086/432056