Authors: Annette Billings MD, Stephen B. Schnall MD, Ian Stine MD
Title: Demographics Of Purulent Flexor Tenosynovitis: An Eleven Year Review
Addresses: 2025 Zonal Ave. GNH 3900,Los Angeles, CA 90089
Purpose: To review all cases of purulent flexor tenosynovitis presenting to Los Angeles County hospital over an eleven year period to determine if there were any changes and or trends in the causative organisms
Methods: After obtaining IRB approval, a retrospective review of 200 consecutive patient charts was carried out. The causative organism(s), antibiotic used for treatment, and comorbid conditions were recorded.
Results: The vast majority of all patients grew out gram positive organisms -Staph Aureus (36.5%), Streptococcus (44.5%) and Staph Epidermis (12.5%). (26% of patients were infected with more than one organism.) 19.5% of patients were infected with proteus, klebsiella, enterococcus,enterobacter or e. coli. This ratio did not change for diabetic patients. However, the prevalence of ORSA was significant. There were no cases with ORSA prior to 2001. In 2001, there was one case (10%); in 2002 there were 7 cases (33% of all patients presenting with FTS); and in 2003 there were 8 cases - again 33% of all patients presenting with FTS. And in the patient population who used intervenous drugs, there were no presenting cases of oxacillin sensitive staph aureus in 2002 or 2003; every case presenting with staph aureus was ORSA (67% and 44% of all presenting cases of FTS respectively).
Discussion: Antibiotic coverage for patients presenting with flexor tenosynovitis typically covers a broad spectrum of organisms. At this institution Irtapenem is used for all patients who present with infection until the antibiotic can be adjusted for the specific organism. However, with the significant increase in the prevalence of ORSA, vancomycin should be considered at least as an adjunct therapeutic agent.
Significance: Oxacillin resistant staph aureus has a significant prevalence in the patient population of LAC, especially in the IVDA population.