O'Malley Michael, Fowler John, Ilyas Asif M
Temple Hand Center, Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA 19422, USA.
J Hand Surg Am. 2009 Mar;34(3):504-8. doi: 10.1016/j.jhsa.2008.11.021.
The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (ca-MRSA) appears to be increasing, but the timeliness of appropriate antibiotic delivery is often delayed. We retrospectively reviewed the prevalence of ca-MRSA infections in an urban setting, time from presentation to the hospital to appropriate antibiotic delivery, and differences in length of stay between the ca-MRSA and non-MRSA hand infections.
We retrospectively reviewed all visits for hand infection cases to the emergency room of an urban academic medical center over a 12-month period. A formal hand infection algorithm was used in the treatment of each patient. All patients with culture-positive hand infections were included for evaluation. Infections determined to be nosocomial or not community-acquired were excluded. Patient demographics, laboratory studies, culture results, antibiotic delivery, and length of stay data were collected.
A total of 85 patients (55 male) with an average age of 39 years met the inclusion criteria. The overall prevalence rate of ca-MRSA hand infections was 55%. The average time to appropriate antibiotic delivery for ca-MRSA infection was 12 hours, versus 2.64 hours for non-MRSA hand infections (p > .5). The average length of stay was 4.0 days for ca-MRSA infections and 3.5 days for non-MRSA infections (p > .05). Univariate and multivariate analysis identified intravenous drug abuse and a serum white blood cell count of >8.7 as independent risk factors for ca-MRSA hand infections.
Community-acquired methicillin-resistant S. aureus infections of the hand continue to increase in urban settings. With the use of a formal hand infection treatment algorithm, we did not identify a statistical difference in appropriate antibiotic delivery time and length of stay between ca-MRSA and non-MRSA hand infections.
社区获得性耐甲氧西林金黄色葡萄球菌（ca-MRSA）的患病率似乎在上升，但合适抗生素给药的及时性常常延迟。我们回顾性分析了城市环境中ca-MRSA感染的患病率、从就诊到医院给予合适抗生素的时间，以及ca-MRSA手部感染与非MRSA手部感染住院时间的差异。
我们回顾性分析了一家城市学术医疗中心急诊室12个月期间所有手部感染病例的就诊情况。对每位患者的治疗采用正式的手部感染治疗方案。所有手部感染培养阳性的患者均纳入评估。排除确定为医院获得性或非社区获得性的感染。收集患者人口统计学资料、实验室检查、培养结果、抗生素给药情况及住院时间数据。
共有85例患者（55例男性）符合纳入标准，平均年龄39岁。ca-MRSA手部感染的总体患病率为55%。ca-MRSA感染给予合适抗生素的平均时间为12小时，而非MRSA手部感染为2.64小时（p>.5）。ca-MRSA感染的平均住院时间为4.0天，非MRSA感染为3.5天（p>.05）。单因素和多因素分析确定静脉药物滥用和血清白细胞计数>8.7是ca-MRSA手部感染的独立危险因素。
在城市环境中，社区获得性耐甲氧西林金黄色葡萄球菌手部感染持续增加。通过使用正式的手部感染治疗方案，我们未发现ca-MRSA与非MRSA手部感染在合适抗生素给药时间和住院时间上存在统计学差异。
