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Antibiotic Sensitivity Profile in Hand Infections: Changing MRSA Drug Resistance Profiles
Rick Tosti; Temple University; Asif M. Ilyas, MD
Thomas Jefferson University, Philadelphia, PA

Background: Acute infections of the hand represent an on-going challenge for treating physicians in endemic regions of community acquired methicillin-resistant Staphylococcus aureus (MRSA). Empiric antibiotics should be selected based on regional prevalence. The purposes of this study were to trend the annual variations of MRSA in hand infections and determine if multi-drug resistant strains of MRSA are emerging.
Methods: A retrospective chart review was performed on all community acquired, culture-positive, hand infections admitted to an urban hospital during a 90-month period from 2005-2012. MRSA infections were additionally analyzed for antibiotic sensitivity.
Results: A total of 516 culture-positive hand infections were identified. Overall, MRSA was cultured in 52% of cases; the annual incidence peaked in 2007 at 64.9% then significantly declined to 41.2% by 2012 (p<0.00005). Polymicrobial infections were observed in 20% of all cases and trended a linear increase from 2005-2011. MRSA was universally resistant to penicillin, oxacillin, and ampicillin. Levofloxacin resistance linearly increased from 12% to 50% (p<0.0005). Clindamycin resistance was not statistically different over the study period (p<0.5), but resistance rates as high as 18% were identified. Resistance to trimethoprim-sulfamethoxazole, tetracycline, gentamycin, and moxifloxacin were only sporadically observed. Resistance to vancomycin, daptomycin, linezolid, and rifampin were not observed.
Conclusion: MRSA remains the most common pathogen in hand infections, however clinically relevant changes in antibiotic resistance profiles were identified over the 8 year study period. We observed a linear increase in polymicrobial infections over the study period. Similarly, resistance to levofloxacin linearly increased over the study period. Although clindamycin is routinely used to manage empiric hand infections, an unacceptably high resistance was also noted. These findings should be taken into account while determining empiric antibiotic treatment of hand infections.


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