Risk factors associated with clindamycin-resistant, methicillin-resistant Staphylococcus aureus in hand abscesses.

Abstract

PURPOSE:

To identify risk factors for clindamycin resistance in acute hand abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA).

METHODS:

We performed a retrospective review of 247 consecutive culture-positive hand abscesses from 2010 to 2012 at an urban hospital. Historical and laboratory data from patients with abscesses that grew MRSA with and without clindamycin resistance were compared in a multivariate analysis.

RESULTS:

Methicillin-resistant Staphylococcus aureus grew on culture from 103 abscesses; 16% of those isolates were resistant to clindamycin. Multivariate analysis showed that younger age, intravenous drug use, and nosocomial acquired MRSA were significant risk factors for concurrent clindamycin resistance. Patients with a history of intravenous drug use and nosocomial acquired MRSA were, respectively, 11 and 5 times more likely to have concurrent clindamycin resistance. History of MRSA infection and human immunodeficiency virus were not identified as risk factors.

CONCLUSIONS:

Patients with a history of intravenous drug use or recent contact with health care facilities appear to be a potential reservoir for emerging multidrug-resistant MRSA. Selection of clindamycin as an empiric antibiotic should be especially avoided for these groups.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Prognostic III.

• Authors: Rick Tosti, Arianna Trionfo, John Gaughan, Asif M Ilyas
• Journal: The Journal of hand surgery (J Hand Surg Am) Vol. 40 Issue 4 Pg. 673-6 (Apr 2015) ISSN: 1531-6564 [Electronic] United States
• PMID: 25707549 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Clindamycin

Topics

• Abscess (microbiology)
• Age Factors
• Anti-Bacterial Agents
• Clindamycin (therapeutic use)
• Cross Infection (drug therapy, epidemiology)
• Drug Resistance, Multiple, Bacterial
• Hand (microbiology)
• Humans
• Methicillin-Resistant Staphylococcus aureus
• Multivariate Analysis
• Risk Factors
• Staphylococcal Infections (drug therapy, epidemiology)
• Substance Abuse, Intravenous (epidemiology)