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MRSA in Community-Acquired Finger Abscess

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ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) emerged in the United States in the 1980s and is considered a nosocomial pathogen. An increasing number of patients have been identified with MRSA isolated from community-acquired finger abscess. This study determined the frequency and possible risk factors associated with MRSA in community-acquired finger abscess in a southeast Texas population.

The medical records of patients diagnosed with finger abscess and treated by our Division of Plastic Surgery over the past 24 months (January 2001 to December 2002) were reviewed. Data recorded included patient age, organisms identified by culture, and possible risk factors for infection.

Average patient age was 36 years (range: 7-79 years). Eleven (61%) of 18 patients treated for finger abscess had culture positive MRSA. Other organisms isolated included methicillin-sensitive S aureus, Streptococcus viridans, Group A beta hemolytic Streptococcus, Enterobacter cloacae, Group D Enterococcus, and Proteus mirabilis. Only 2 (18%) of 11 patients with positive MRSA cultures had identifiable risk factors (1 patient was admitted to the hospital within the previous 12 months and 1 patient had a history of intravenous drug use). Other risk factors for MRSA such as nursing home residence, chronic antibiotic use, or long-term hemodialysis were not identified.

Methicillin-resistant S aureus infection in community-acquired finger abscess was identified in 61% of patients. The majority of patients with positive MRSA cultures had no identifiable risk factors, suggesting that MRSA may be more prevalent in the community than once believed. A plausible explanation is that the use of broad-spectrum antibiotics for community-acquired infections has increased the pressure to select MRSA and other resistant bacteria. The empiric use of synthetic penicillins and cephalosporins for treatment of community-acquired staphylococcal infections may no longer be appropriate for many patients. Another possible factor is the heavy use of antibiotics in animal feedlots. Further studies of risk factors for MRSA transmission in the community will help define other possible sources of this infection.