LeBlanc Danielle M, Reece Edward M, Horton J Bauer, Janis Jeffrey E
Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235-9132, USA.
Plast Reconstr Surg. 2007 Mar;119(3):935-40. doi: 10.1097/01.prs.0000252270.84195.41.
Staphylococcus aureus is the most common cause of skin and soft-tissue infections. Methicillin-resistant S. aureus and community-acquired methicillin-resistant S. aureus have shown an increase in prevalence among soft-tissue infections over the past several years, with overall rates approaching 50 percent at the authors' institution in 2002. The object of this study was to determine the incidence of methicillin-resistant S. aureus with respect to hand infections, the antibiotic resistance pattern of methicillin-resistant S. aureus isolates, and implications for a change in antibiotic treatment algorithms for hand infections.
A retrospective chart review of 761 patients with hand infections tracked by International Classification of Diseases, 9th Revision codes for finger or hand abscesses from 2001 to 2003 was performed at Parkland Memorial Hospital, Dallas, Texas. Culture results were obtained from 436 patients and analyzed for type of organism, and sensitivity profiles were obtained for all methicillin-resistant S. aureus isolates.
The median age of 761 patients was 40 years (range, 16 to 77 years); 71 percent were male and 28 percent were female. Of the 436 cultures reviewed, 371 (85 percent) had organisms identified. Methicillin-resistant S. aureus was the dominant single organism in hand infections cultured in all 3 years. The overall methicillin-resistant S. aureus rate was 61 percent of all hand infections in 2003. The percentage of S. aureus isolates identified as methicillin-resistant S. aureus increased from 55 percent to 78 percent over 3 years, up from 34 percent in 2001. Fortunately, 86 percent of these methicillin-resistant S. aureus isolates demonstrated sensitivity to conventional antibiotics, but a trend of resistance is developing.
The incidence of community-acquired methicillin-resistant S. aureus increased from 34 percent to 61 percent over a 3-year period at the authors' county institution. An increasing trend of resistance patterns among conventional antibiotics was also demonstrated. As a result of this study, the treatment algorithm at Parkland Memorial Hospital has been modified to include abscess drainage accompanied by an antibiotic regimen targeted specifically at methicillin-resistant S. aureus. These data also have implications for broader application regarding simple skin infections and current antibiotic treatment algorithms.
金黄色葡萄球菌是皮肤和软组织感染最常见的病因。耐甲氧西林金黄色葡萄球菌及社区获得性耐甲氧西林金黄色葡萄球菌在过去几年中在软组织感染中的患病率有所上升，2002年在作者所在机构总体患病率接近50%。本研究的目的是确定手部感染中耐甲氧西林金黄色葡萄球菌的发病率、耐甲氧西林金黄色葡萄球菌分离株的抗生素耐药模式，以及对手部感染抗生素治疗方案改变的影响。
对德克萨斯州达拉斯帕克兰纪念医院2001年至2003年按照国际疾病分类第九版编码追踪的761例手部感染患者进行回顾性病历审查，这些患者的诊断为手指或手部脓肿。从436例患者获得培养结果，分析病原体类型，并获得所有耐甲氧西林金黄色葡萄球菌分离株的敏感性谱。
761例患者的中位年龄为40岁（范围16至77岁）；71%为男性，28%为女性。在审查的436份培养物中，371份（85%）鉴定出病原体。耐甲氧西林金黄色葡萄球菌是所有3年中手部感染培养中占主导地位的单一病原体。2003年耐甲氧西林金黄色葡萄球菌在所有手部感染中的总体发生率为61%。被鉴定为耐甲氧西林金黄色葡萄球菌的金黄色葡萄球菌分离株百分比在3年中从55%增加到78%，2001年为34%。幸运的是，这些耐甲氧西林金黄色葡萄球菌分离株中有86%对传统抗生素敏感，但耐药趋势正在形成。
在作者所在的县级机构，社区获得性耐甲氧西林金黄色葡萄球菌的发病率在3年期间从34%增加到61%。传统抗生素的耐药模式也呈上升趋势。由于本研究，帕克兰纪念医院的治疗方案已作修改，包括脓肿引流并伴有专门针对耐甲氧西林金黄色葡萄球菌的抗生素治疗方案。这些数据对于简单皮肤感染及当前抗生素治疗方案的更广泛应用也有影响。
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