Aim and Objectives:
Prompt recognition and treatment of deep space MRSA upper extremity infections is critical to reducing permanent loss of hand function. Rapid screening tools for MRSA colonization exist and are implemented for purposes of contact isolation in hospitals. We sought to explore the predictive value of MRSA screening with clinically significant MRSA infections among patients admitted to our regional unit.
Methods:
ICD10 codes were used to identify all patients admitted to the Auckland Regional Hand Unit with upper extremity infections between 2011 and 2014 inclusive, and these patients were cross referenced with all microbiology data obtained over the same study period. Rates of admission screening for MRSA by nasal swabs and correlation with operative cultures were evaluated.
Results:
966 patients treated for upper extremity infections had clinical culture data collected from their infection. Of these, 285 patients (29.5%) also underwent admission MRSA screening. Among patients where both MRSA screening and clinical cultures were collected, 33 patients (11.6%) were MRSA screen positive and 44 patients (15.4%) were MRSA clinical culture positive. The positive and negative predictive power of MRSA screening for invasive upper extremity infections was 70 and 92%, respectively. The sensitivity and specificitywas 52.2% and 95.9%, respectively.
Conclusions:
To our knowledge this is the first study to specifically correlate MRSA carrier status with upper extremity infections. Limitations include the relatively low rate of MRSA screening among treated patients. Despite this limitation, because MRSA carrier status can be obtained by rapid PCR testing within 24 hours of admission, further studies are warranted to investigate the utility of MRSA screening for improved, responsible and early targeted antibiotic treatment in high risk upper extremity infections.