Increasing Multidrug Antibiotic Resistance in MRSA Infections of the Hand: A 10-Year Analysis of Risk Factors.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen isolated from hand abscesses. The purpose of this study was to understand trends and changes in longitudinal antibiotic resistance profiles and risk factors for these infections to better guide empiric treatment of hand infections.

METHODS: We performed a retrospective review of culture-positive hand infections over a 10-year period at an urban academic institution from 2005 to 2014. A subset of MRSA hand infections from 2013 to 2014 was then subanalyzed for risk factors for antibiotic resistance for antibiotics with increasing antibiotic resistance during this period.

RESULTS: MRSA grew in 46% of hand infections, with a decreasing incidence over the 10-year study period. However, in the same time period clindamycin and levofloxacin resistance increased from 7% to 31% and 12% to 56%, respectively. Risk factors for clindamycin resistance included nosocomial infections and a history of intravenous drug use and hepatitis C. Risk factors for levofloxacin resistance included a history of diabetes and a fever upon initial presentation.

CONCLUSIONS: The incidence of multidrug resistance remains high, with growing resistance to clindamycin and levofloxacin. There remains a trend for increased clindamycin resistance for patients with history of intravenous drug use and nosocomial infections. Our findings indicate that clindamycin and levofloxacin should be avoided for empiric treatment for hand infections in patients with these risk factors.