Skin abscesses with MRSA: How to manage

March 26, 2014

It has been more than a decade since the clinical battle began with community-acquired methicillin-resistant Staphylococcus aureus (MRSA), and physicians are still trying to figure out how to diagnose, treat, and prevent this virulent form of staph infection, which is immune to many antibiotics.

Researchers at UCLA Medical Center have issued updated guidelines, published in the New England Journal of Medicine, that outline the best ways to manage skin abscesses associated with community-acquired methicillin-resistant Staphylococcus aureus (MRSA).

“The report is intended to update clinicians on the latest information regarding ways to treat patients with skin abscesses,” David A. Talan, MD, a professor in the division of infectious diseases and chief of the department of emergency medicine at Olive View–UCLA Medical Center, Sylmar, Calif., told FormularyWatch.

In addition to using their clinical experience and expert opinion, Dr Talan and Adam Singer, MD, department of emergency medicine at Stony Brook University in New York, looked at the medical literature for the best evidence surrounding the topic of skin abscesses, and developed the report based on this.

 

According to Dr Talan, the report discusses diagnostic techniques, such as using ultrasound of the soft tissue, and surgical management. In addition, the report provides an overview of the latest understanding on treatment options, including information about how to drain an abscess with minimal discomfort to the patient, and without leaving a scar. It also addresses causes of abscesses, particularly among patients with recurring infections, and discusses strategies that can be used to prevent recurrence of infections, including antibiotic treatment.

“Most patients who have a minor abscess can be treated as outpatients with inexpensive oral antibiotics,” Drs Talan and Singer wrote. “TMP-SMX, clindamycin, and tetracycline have been shown to have in vitro activity against 94% to nearly 100% of more than 300 MRSA isolates tested in a 2008 U.S. emergency department-based surveillance study.”

However, resistance to clindamycin and tetracyclines has occurred in some communities, so healthcare professionals need to know of local susceptibility patterns. The Infectious Diseases Society of America (IDSA) recommends TMP-SMX (trimethoprim-sulfamethoxazole), clindamycin, doxycycline, and minocycline for certain patients with a presumed MRSA abscess. These patients have severe or extensive disease with multiple infection sites or rapid progression with cellulitis, signs of systemic illness, an abscess in a difficult area to treat, the presence of septic phlebitis, or no response to incision and drainage. Also, IDSA suggests antibiotic treatment in the very young and elderly.

Additionally, the need for collaboration between ER and hospitalist physicians is important more than ever, as both specialties are looking for new diagnostic techniques, the most effective treatments, and best practices on the most effective antibiotics.

 

“Causes of and treatments for skin abscesses are important to both parties as they work toward reducing ER boarding time and unnecessary hospital admissions, while simultaneously working to improve patient care and satisfaction,” Dr Talan said.

He offered the following prevention guidance:

• People with skin infections should be careful to keep lesions covered with a dressing or adhesive bandage and wash their hands thoroughly after changing the bandage. Place bandages in the trash.
• Avoid sharing personal items like towels, razors, or brushes with people who have an active skin infection.

“Skin abscesses may seem like an old problem, but it’s important to understand that a number of things have changed in recent years with regard to diagnosis and treatment,” Dr Talan said. “I encourage healthcare providers to review the report in full to become familiar with advances in this area of treatment.”