MRSA Incidence and Antibiotic Trends in Urban Hand Infections: A Ten-Year Longitudinal Study
Justin Kistler, MD; Temple University, Philadelphia, PA; Joseph Thoder, M.D.; Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, PA; Asif Ilyas, MD; Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
Methicillin-resistant Staphylococcus aureus (MRSA) has been the most reported pathogen in hand infections at urban medical centers throughout the country. Antibiotic sensitivity profiles are continually evolving, but trends are not well known. The purposes of this study were to examine the epidemiology and determine the drug resistance trends for MRSA infections of the hand and to provide recommendations for empiric antibiotic treatment based on sensitivity profiles.
A ten-year longitudinal and consecutive, retrospective chart review was performed on all culture-positive hand infections encountered at a single urban medical center from 2005 to 2014. The proportions of all organisms were calculated for each year and collectively. MRSA infections were additionally sub-analyzed for antibiotic sensitivity.
A total of 815 culture-positive hand infections were identified. Overall, MRSA grew on culture in 40% of cases, with the highest annual incidence peaking in 2007 at 65%. However, during the ten-year study period there was a decrease in overall MRSA prevalence reaching a nadir of 27% in 2014. While there was a drop in MRSA infection incidence over the ten-year study period, there was a steady increase in polymicrobial infections during that same 10 years, starting at 7% in 2005 and eventually peaking at 39% in 2014. Relative to antibiotic sensitivity, MRSA hand infections were universally resistant to penicillin, oxacillin, and ampicillin. Clindamycin resistance increased steadily during the course of the study, starting at a nadir of 4% in 2008 but growing to 31% by 2014. Similarly, levofloxacin resistance also consistently increased throughout the study reaching its peak at 56% in 2014.
The annual incidence of MRSA in hand infections has declined overall, but with an alternative increase in the number of polymicrobial infections. In addition, MRSA resistance to clindamycin and levofloxacin has consistently increased over the past 10 years. These findings present a new challenge in treating hand infections. Empiric antibiotic therapy for hand infections should not only avoid penicillin and its synthetic alternatives, but based on this study's findings should also consider avoiding clindamycin and levofloxacin for empiric treatment.
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