Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) emerged in the United States in the 1980s and is considered largely a nosocomial pathogen. We have noticed, however, an increasing number of patients with MRSA isolated from community-acquired finger abscess. The purpose of this study is to determine the frequency and possible risk factors associated with MRSA in community-acquired finger abscess in our southeast Texas population.

Methods: The medical records of patients diagnosed with finger abscess and treated by our Division of Plastic Surgery over the last 24 months (January 2001 to December 2002) were reviewed. Data recorded included age of patient, organisms identified by culture, and possible risk factors for infection.

Results: The ages of patients treated for finger abscess ranged from 7 to 79 years, with an average age of 36 years. 11 of 18 patients treated for finger abscess, or 61% of patients, had culture positive methicillin-resistant Staphylococcus aureus. Other organisms isolated included methicillin-sensitive Staphylococcus aureus, Streptococcus viridans, Group A beta hemolytic Streptococcus, Enterobacter cloacae, Group D Enterococcus, and Proteus mirabilis. Only 2 of the 11 patients (18%) with positive MRSA cultures had identified risk factors (one patient had hospital admission within the previous 12 months, and one patient had a history of intravenous drug use). Other risk factors for MRSA such as nursing home residence, chronic antibiotic use, or long-term hemodialysis were not identified.

Conclusions: Methicillin-resistant Staphylococcus aureus infection in community-acquired finger abscess was identified in 61% of our patients. The majority of patients with positive MRSA cultures had no identified risk factors, suggesting that MRSA may be more prevalent in the community than once believed. A plausible explanation is that the use of broad-spectrum antibiotics for community-acquired infections has increased the pressure to select MRSA and other resistant bacteria. The empiric use of synthetic penicillins and cephalosporins for treatment of community-acquired staphylococcal infections may no longer be appropriate for many patients. Another possible factor is the heavy use of antibiotics in animal feedlots. Further studies of risk factors for MRSA transmission in the community will help to define other possible sources of this infection.