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Risk Factors Associated with Emerging Clindamycin Resistant MRSA in Hand Infections
Rick Tosti, MD; Asif Ilyas, MD
Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Purpose: Methicillin Resistant Staphylococcus Aureus (MRSA) is the most common pathogen identified in hand infections at urban centers. A number of oral agents including clindamycin are routinely utilized for empiric antibiotic management. However, concurrent clindamycin resistance in MRSA hand infections has also recently been reported to be on the rise. The purpose of this study was to identify risk factors for clindamycin resistance in acute hand abscesses caused by MRSA.

Methods: A retrospective review of 247 consecutive culture-positive hand abscesses from 2010-2012 was performed at an urban hospital. Demographic and laboratory data from patients with abscesses that grew MRSA with and without clindamycin resistance were compared in a multivariate analysis.

Results: MRSA grew on culture from 103 abscesses with a total incidence of 42%. Among these MRSA infections, 16% were resistant to clindamycin. Multivariate analysis showed that intravenous drug use (P=0.002) and nosocomial-acquired MRSA (P=0.04) were significant risk factors for concurrent clindamycin resistance. Patients with a history of intravenous drug use and nosocomial-acquired MRSA were respectively 8.4 and 3.6 times more likely to have concurrent clindamycin resistance. History of immunosuppression, prior history of MRSA, and human immunodeficiency virus were not identified as risk factors.

Conclusion: Patients with a history of intravenous drug use or recent contact with health-care facilities appear to be a reservoir for clindamycin resistant MRSA. When selecting empiric antibiotics for treatment of a hand abscess, clindamycin should be prescribed with caution in these groups.

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