Authors: David J. Downs, MD, Montri D. Wongworawat, MD*
Title: Timeliness of Appropriate Antibiotics in Hand Surgery
Addresses: Department of Orthopaedic Surgery, Loma Linda University East Campus, 11406 Loma Linda Drive, Suite 218, Loma Linda, CA 92354
Purpose: The objective of this study is to determine if a significant difference in time to appropriate antibiotic treatment exists between methicillin resistant staphylococcus species (MRS) and non-MRS hand infections.
Methods: Electronic medical records for the orthopaedic department from 2003-2005 were queried based on ICD-9 codes for infections of the hand. Patients were included in the study only if they had a culture positive hand infection and received antibiotic treatment. Patients in which no cultures were obtained, those with negative cultures, or those patients who were not treated with antibiotics were excluded. As precisely as possible the age, gender, time of presentation, time of receiving any antibiotic, time of final culture results, and time of receiving culture appropriate antibiotics were recorded for each patient.
Results: 110 patients were identified by ICD-9 code. Of these, thirty-two patients met the inclusion criteria. There were eighteen males and fourteen females. Average age was 39.1 years (range 6 months to 72 years). The prevalence of MRS was thirty-four percent. Data was analyzed using the Log-Rank test. The difference in time to any antibiotic (non-MRS 0.26 days, MRS 0.63 days) was not significant, p = 0.1397. The difference in time to appropriate antibiotics (non-MRS 0.39 days, MRS 2.19 days) was significant, p = 0.0002.
Discussion: A significant delay in receiving appropriate antibiotics exists between MRS and non-MRS hand infections in this patient set. This study supports efforts to develop rapid detection MRS tests as well as early empiric coverage for community acquired methicillin resistant staphyloccus species in hand infections.