Optimizing Treatment of Hand Infections: Is MRSA Coverage Always Necessary?

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Surgical Infections

Background:

• Multiple publications have emphasized the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in hand infections.
• This has potentially influenced the empiric antibiotic treatment strategies for these infections.

Purpose of the Study:

• To identify the current standard of care for hand infections.
• To determine the most common bacterial pathogens causing hand infections.
• To identify factors contributing to prolonged hospital stays for patients with hand infections at a suburban hospital.
• To optimize treatment protocols and improve patient outcomes.

Main Methods:

• Retrospective cohort analysis of patients admitted for hand infections over an 8-year period.
• Comprehensive chart review of each patient's hospital course.

Main Results:

• Elevated white blood cell count (≥ 12) was significantly associated with a longer hospital stay (9.1 vs. 5.4 days).
• Vancomycin was empirically used in 97.1% of patients, despite only 20% having MRSA-positive cultures.
• High initial vancomycin trough levels (> 20) correlated with increased length of stay and elevated creatinine levels.

Conclusions:

• The incidence of MRSA hand infections may vary significantly between institutions.
• Hospitals should conduct internal data reviews to tailor hand infection treatment protocols.
• Optimizing treatment based on local data can improve patient care and reduce healthcare costs.