Community-acquired methicillin-resistant Staphylococcus aureus hand infections in the pediatric population

Acute-Phase Reactants in Operatively Treated Upper Extremity Infections: A Retrospective Review

Background: There are limited data on the use of acute-phase markers in the diagnosis of upper extremity infections. The goal of this study was to determine the percentage of patients with elevated white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the setting of an upper extremity infection requiring operative debridement. Methods: In a retrospective review over 12 years, 61 patients who met the inclusion criteria were identified. Results: C-reactive protein was the most sensitive test in the detection of culture-positive infection compared with ESR and WBC (P < .001, P < .0001, respectively). Ninety percent of patients (55 of 61) presented with an abnormal CRP value. The WBC count and ESR were abnormal in 54% and 67% of our cohort, respectively. Conclusions: C-reactive protein is the most sensitive laboratory test when evaluating upper extremity infections that necessitate debridement. The WBC count and ESR should be interpreted with caution and can be normal even in the presence of an infection.

Diagnosis and Management of Common Hand Infections

While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity. Maintaining a wide differential diagnosis is important as some hand infections may mimic others. In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA. Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.

Antibiotic Management and Antibiotic Resistance in Hand Infections

The rates of methicillin-resistant infections in the hand and upper extremity approach 50% in many facilities. In addition, multidrug resistance is beginning to include clindamycin. This article discusses the history, prevalence, and treatment of both community-acquired and health care-associated methicillin-resistant Staphylococcus aureus in regard to hand infections.

Methicillin-resistant Staphylococcus aureus infection in the hand

BACKGROUND

Methicillin-resistant Staphylococcus aureus has become an increasingly common cause of skin and soft-issue infections. The purpose of this study was to review and summarize the most recent literature on methicillin-resistant S. aureus infections of the hand.

METHODS

The English-language literature related to methicillin-resistant S. aureus infections of the hand was reviewed, and information related to the history, epidemiology, clinical presentation, and treatment of methicillin-resistant S. aureus infections of the hand was summarized.

RESULTS

Community-acquired methicillin-resistant S. aureus hand infections have increased rapidly in prevalence over the past two decades. The prevalence varies markedly around the world, but in the United States, community-acquired methicillin-resistant S. aureus now causes the majority of purulent hand infections.

CONCLUSIONS

Purulent hand infections should be treated with surgical drainage. When antibiotics are indicated, empiric coverage for community-acquired methicillin-resistant S. aureus should be provided if local prevalence rates exceed 10 to 15 percent.

Epidemiology of adult acute hand infections at an urban medical center

PURPOSE

To define the current epidemiology of adult acute hand infections in an urban setting, with the aim of helping to improve empiric treatment, as hand infections represent a major source of morbidity and can result in stiffness and, possibly, amputation.

METHODS

We performed an electronic medical record search to identify all patients admitted to our urban academic medical center with diagnoses related to open wounds and infections in the hand and fingers over a 6-year period (2005-2010). We recorded demographic data, location of infection, medical comorbidities, and culture data.

RESULTS

Of the 2,287 patients admitted with diagnoses related to open wounds and infections in the hand and fingers, 1,507 incision and drainage procedures were performed, which resulted in 458 patients (30%) with culture-positive infections. Wound cultures identified 39 different species of bacteria. Most of these were methicillin-resistant Staphylococcus aureus, which compromised 53% of positive cultures, followed by methicillin-sensitive S aureus in 23% of positive cultures. The cultures were polymicrobial in 19%. History of intravenous drug use or diabetes mellitus was a strong predictor of polymicrobial infection.

CONCLUSIONS

Methicillin-resistant Staphylococcus aureus was the most common bacteria cultured from these infections. Empiric antibiotic coverage should routinely cover methicillin-resistant S aureus. We noted a higher incidence of polymicrobial infections than previously reported, particularly with intravenous drug use, diabetes, and human bites. Volar hand infections had the highest percentage of positive cultures, whereas paronychia had the lowest percentage.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.