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No Set Guidelines Other Than "Be Aggressive" for Antibiotic Use for Community-Acquired MRSA of the Hand

Community-acquired methicillin-resistant staphylococcus aureus (MRSA) is becoming more common in among the general population, not just those who are ill. While most healthy people aren't affected by MRSA, the high rate of community-acquired MRSA can be dangerous to those who are weaker and those with chronic illnesses, like diabetes. Sixty percent of people with diabetes develop complications from MRSA compared with only 11 percent of people who don't have diabetes.

Risk factors for developing community-acquired MRSA include living in crowded quarters, taking antibiotics within the previous year, having broken skin (cuts, lesions, scrapes, etc), and sharing equipment like sports equipment or showers. If you develop MRSA infection in the hospital or clinic setting, this is called nosocomial MRSA. Patients who have this type of MRSA infection have been found to have higher rates of death (up to three times higher) if there is a delay in giving antibiotics.

Because of the increased costs due to community-acquired MRSA and the health risks, the authors of this article wanted to see if they could determine a set of steps or rules (an algorithm) that would help doctors know when to start antibiotic therapy and for how long to give it.

Researchers reviewed the cases of people who were seen in a local emergency room for hand infections over the course of a year. The patients had to be between 18 and 89 years old, have tests to confirm the infection, couldn't have a history of MRSA infection, were admitted for treatment, and were not exposed to nosocomial MRSA.

The researchers then examined the types of infections the patients had, which antibiotics were used, if they worker or had to be changed, how long the antibiotics were given for, and how long the patients were kept in the hospital, among other pieces of data. In gathering the data, the researchers found that 85 patients were eligible for the study. Forty seven patients had community-acquired MRSA and 38 had infections caused by other bacteria.

The most common injuries had been caused by cuts (16 patients), puncture wounds (12 patients), and human bite (9 patients). On average, the patients were in the hospital for four days if they had community-acquired MRSA and 3.5 days if they had an infection from a different bacteria. Those patients with the MRSA infection were usually treated within 12 hours of coming to the emergency, while those with other types of infection were treated within 2.64 hours. The delay was due to the culture, testing, process where it is determined which antibiotics would be most likely to treat the infection.

An interesting finding from this study showed that intravenous drug abuse significantly raised the risk of developing community-acquired MRSA infection - by almost 15 times.

In conclusion, the authors say that hand infections "must be treated aggressively" with antibiotics and, if needed, draining of the wound. But, having a set step-by-step guideline doesn't seem to affect how long it takes for community-acquired MRSA infections to heal over other types of infections of the hand.


Michael O'Malley, BS, John Fowler, MD, and Asif M. Ilyas, MD. Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections of the Hand: Prevalence and Timeliness of Treatment. In The Journal of Hand Surgery<\i>. March 2009. Vol. 34. No. 3. Pp. 504 to 508.

03/11/2009

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