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Nasal Methicillin-Resistant Staphylococcus aureus Swabs as a Predictor in Community-Acquired Hand Infections
Jacob D Franke, MD
1, Reece A Moore, MD
1, Sandeep Vemulapalli, MS
2; Matthew P Fahrenkopf, MD
3(1)Michigan State University/Corewell Health, Grand Rapids, MI, (2)Corewell Health, Grand Rapids, MI, (3)Elite Hand and Plastic Surgery Centre, Grand Rapids, MI
Introduction: The variance in the prevalence of community-acquired Methicillin-Resistant
Staphylococcus aureus (MRSA) hand infections across institutions poses a therapeutic challenge that leads to unnecessary antibiotic coverage and adverse outcomes. Nasal MRSA polymerase chain reaction (PCR) swabs have been utilized as a predictor for MRSA-positive cultures in skin and soft tissue infections, but their utility in community-acquired hand infections is not currently known.
Methods: A retrospective analysis was conducted from January 2024 to May 2025 of all patients with community-acquired hand infections at three hospitals of a midwestern health system, including a level one trauma center and one children's hospital. Only patients with both 1) results from a nasal MRSA swab and 2) procedurally obtained, culture-positive infections by the hand surgery service collected during the same clinical encounter or admission were included. Demographic information, culture data, nasal MRSA PCR swab results, and hand infection type were collected. Sensitivity, specificity, positive predictive value, and negative predictive value was calculated.
Results: A total of eighty-four patients were identified during the study period. The majority of the patients were male 60/84 (71.4%) with an average age of 51.6 years (range 2 - 97). Cultures grew methicillin-sensitive
Staphylococcus aureus in 27/84 (32.1%), MRSA in 18/84 (21.4%) including three polymicrobial cultures containing MRSA, polymicrobial without MRSA in 15/84 (17.9%), and
Streptococcus pyogenes in 9/84 (10.7%). Nasal MRSA PCR swabs had a sensitivity and specificity of 77.8% and 92.4%, respectively. The positive predictive value was 73.7% with a negative predictive value of 93.8%.
Conclusion: The results demonstrate that nasal MRSA swabs have acceptable sensitivity and high specificity in predicting community-acquired MRSA hand infections. Nasal MRSA swabs show clinical promise and have the potential to serve as a useful tool in antimicrobial treatment decisions for infections of the hand.
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