Letter regarding "community-acquired methicillin-resistant Staphylococcus aureus hand infections in the pediatric population".

PURPOSE Recent studies have reported rates of methicillin-resistant Staphylococcus aureus (MRSA) hand infections in patients without risk factors ranging from 26% to 73%. The purpose of our study was to review a large series of pediatric hand infections to determine the rate of MRSA and identify potential risk factors. METHODS A retrospective review was performed on patients younger than 15 who were seen for hand infections (2001-2010). Patients were categorized according to medical problems, need for operation, abscess location, and mechanism of injury. Potential MRSA risk factors were assessed using a multivariate-regression model. RESULTS During the 10-year period, 415 patients were seen for hand infections. A total of 146 patients met the inclusion criteria: patients younger than 15 years of age who presented to the plastic surgery service requiring consultation for hand infections. The overall prevalence of MRSA-positive cultures was found to be 30%. The prevalence of MRSA was 29% in healthy patients and 0% in immunocompromised patients. The prevalence of MRSA increased in a linear fashion from patients without documentation of incision and drainage procedures to patients adequately treated with bedside incision and drainage to patients who required surgical drainage. There was a trend toward a higher prevalence of MRSA in deep space abscesses compared to other abscesses. Patients with a history of trauma and previous MRSA infections had a higher rate of MRSA than other patients. CONCLUSIONS Traditionally, MRSA has been associated with hospitalization, intravenous drug use, recent antibiotic use, and compromised immunity. In our study, more severe, deep-space abscesses requiring surgical drainage and patients with a history of previous MRSA infections were found to have a higher prevalence of MRSA. The immunocompromised patients had no cases of MRSA and had higher incidences of less virulent bacterial infections. This suggests that acquisition of community-acquired MRSA skin and soft tissue infections in children and adolescents might not be associated with the traditional risk factors. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.