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Seasonal Variation and Epidemiology of Upper Extremity Infections in a Community Based Hospital over a Six-Year Period
Jeremy R. Chidester, MD1; Milan V. Stevanovic, MD2; Frances E. Sharpe, MD3
1Loma Linda University Health, Loma Linda, CA; 2University of Southern California, Los Angeles, CA; 3Kaiser Permanente, Fontana, CA

Introduction: The empiric treatment of hand infections requires knowledge of common infecting organisms for different types of infections. Several recent studies indicate an increasing trend of methicillin resistant organisms in upper extremity infections.1,2 There have been few recent epidemiologic studies identifying common organisms for different types of hand infections.3 Knowing the expected organism allows the clinician to better select empiric antibiotic therapy while awaiting final culture results.4 There have been no studies regarding the seasonal variation in upper extremity infections. We looked at the seasonal variation and epidemiology of upper extremity infections to identify possible correctable factors.
Materials & Methods: A retrospective chart review was performed at a community-based hospital in Southern California over a six-year period, from March 2008 to December 2013. We searched the electronic health record for International Statistical Classification of Diseases (ICD-9) diagnosis codes specific to hand infections (681.0, 682.9, 711.4, 727.89, etc.), and procedural codes related their surgical treatment (86.04, 78.26, 86.2). We identified the following: type of hand infection; geographic location; month of treatment; season of the year. Student t-test was used to compare month-to-month, seasonal and annual differences. Significance was defined as p < 0.05.
Results: There was a significant upward trend in the total incidence of upper extremity infections in the summer (June, July, August) annually when compared to the winter seasons (December, January, February). There were on average 16.35 documented cases per month (SD 2.31+/- 0.67) of upper extremity infection. We found 55.4 cases reported on average during the summer. In the spring, fall, and winter, there were 50.4, 45.4, and 45.0 cases reported on average over that same time period, respectively. Additionally, there was a significant spike in infections in July (p = 0.0196), with an average of 22.6 (SD 6.82 +/- 3.05) cases annually when compared to the winter month of February with 13.6 (SD 6.46 +/-2.89) cases on average [Figure 1]. There was trending significance when comparing the number of annual infections in July to May (p = 0.0813) and July to October (p = 0.0855).
Conclusion: There appears to be a significant seasonal trend in incidence of upper extremity infections, peaking in the month of July annually. There are also trends toward significant seasonal differences when comparing the summer months to the other seasons of the year. Further studies and data are needed to potentially find a correctable factor attributable to the seasonal variation in the incidence of upper extremity infection.

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