Chung MT, Wilson P, Rinker B. Community-acquired methicillin-resistant Staphylococcus aureus hand infections in the pediatric population.
J Hand Surg Am 2012;
37:326-31. [PMID:
22192163 DOI:
10.1016/j.jhsa.2011.10.048]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE
Recent studies have reported rates of methicillin-resistant Staphylococcus aureus (MRSA) hand infections in patients without risk factors ranging from 26% to 73%. The purpose of our study was to review a large series of pediatric hand infections to determine the rate of MRSA and identify potential risk factors.
METHODS
A retrospective review was performed on patients younger than 15 who were seen for hand infections (2001-2010). Patients were categorized according to medical problems, need for operation, abscess location, and mechanism of injury. Potential MRSA risk factors were assessed using a multivariate-regression model.
RESULTS
During the 10-year period, 415 patients were seen for hand infections. A total of 146 patients met the inclusion criteria: patients younger than 15 years of age who presented to the plastic surgery service requiring consultation for hand infections. The overall prevalence of MRSA-positive cultures was found to be 30%. The prevalence of MRSA was 29% in healthy patients and 0% in immunocompromised patients. The prevalence of MRSA increased in a linear fashion from patients without documentation of incision and drainage procedures to patients adequately treated with bedside incision and drainage to patients who required surgical drainage. There was a trend toward a higher prevalence of MRSA in deep space abscesses compared to other abscesses. Patients with a history of trauma and previous MRSA infections had a higher rate of MRSA than other patients.
CONCLUSIONS
Traditionally, MRSA has been associated with hospitalization, intravenous drug use, recent antibiotic use, and compromised immunity. In our study, more severe, deep-space abscesses requiring surgical drainage and patients with a history of previous MRSA infections were found to have a higher prevalence of MRSA. The immunocompromised patients had no cases of MRSA and had higher incidences of less virulent bacterial infections. This suggests that acquisition of community-acquired MRSA skin and soft tissue infections in children and adolescents might not be associated with the traditional risk factors.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic IV.
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