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

J Hand Surg Am. 2015 Apr;40(4):673-6. doi: 10.1016/j.jhsa.2014.12.044. Epub 2015 Feb 21.

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.

Keywords: MRSA; antibiotic resistance; clindamycin; hand infection.

Publication types

  • Comparative Study

MeSH terms

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

Substances

  • Anti-Bacterial Agents
  • Clindamycin