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The Declining Incidence of MRSA Hand Infections
John Fowler; Mitchell Maltenfort; Asif M. Ilyas, MD; Thomas Jefferson University
Rothman Institute / Thomas Jefferson University, Philadelphia, PA, USA

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as the most common pathogen cultured from hand infections in many centers. MRSA has been found to correlate with increased morbidity and increased length of stay. Multiple studies have found the incidence of MRSA to be increasing in recent years. The purpose of this study is to determine whether the incidence of MRSA continues to grow and to determine if MRSA is a risk factor for increased length of stay.

Methods: Records were queried to identity all patients admitted to an academic urban medical center with the diagnosis of a hand infection from 1/1/2005 to 9/30/2010. The following IDC-9 codes were used: 681.00, 681.01, 681.02, 682.4, 727.05, 727.9, 883.00, 883.1, 882.01, and 882.00 (cellulitis, abscess, tenosynovitis, and open wounds of the fingers and hands). The following inclusion criteria were used: 1) age 18-89; 2) underwent incision and debridement (I&D) with a culture performed; and 3) medical records were available for review. The query identified 2287 total patients, of which 1507 underwent I&D and 464 (30.8%) had positive cultures.

Results: MRSA accounted for 243/464 (52.4%) of the positive cultures over the study period. The second most common pathogen was MSSA, 103/464 (22.2%), followed by polymicrobial infection, 88/464 (19.0%). The yearly annual incidence of MRSA infections over five years from 2005-2009 was 46 (52.9%), 65 (62.5%), 54 (64.3%), 31 (38.8%), and 24 (36.9%), respectively. (p<0.001) The incidence of polymicrobial infection increased from 2005-2010 with 6 (6.9%), 12 (11.5%), 11 (13.1%), 31 (41.3%), and 14 (21.5%), respectively. (p<0.005) MRSA had a median length of stay (LOS) of 4 days (IQR 2-5) compared to non-MRSA infections that had a median length of stay of 3 days (IQR 2-5), p < 0.0001. Polymicrobial infection had a median length of stay of 4 days (IQR 2-5) compared to non-polymicrobial infection with a median LOS of 0 days (IQR 0-2), p < 0.0001.

Discussion: Although MRSA remains the most common infection of the hand, this large multi-year longitudinal series of culture positive hand infections has demonstrated a decreasing trend of MRSA and an increasing trend of polymicrobial infections. MRSA and polymicrobial infections result in increased LOS compared to non-MRSA and non-polymicrobial infections. Given this trend, consideration should be given to including broad spectrum antibiotics in addition to empiric coverage for MRSA in the management of hand infections.

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