FeedbackThis pathogen causes skin infections presented as cellulitis, impetigo, folliculitis, furunculosis, carbuncles, abcesses, and infected lacerations. The patient has no history of hospitalization, admission to a nursing home, dialysis, surgery or inserted medical devices in the last year. The diagnosis is made either in the outpatient setting or within the first 48 hours of admission to a medical facility. The patient has no history of MRSA infection.
Treatment
This begins with incision, drainage and localized care. Diagnosis by culture is useful in recurrent cases or in cases of antibiotic failure. If patient is found to have a MRSA skin infection and antibiotics are indicated, use culture results to select an antibiotic to which the organism is susceptible. If the strain is sensitive to Rifampin, that drug should never be given alone because of rapid development of resistance.
The USA 300 clone is becoming the dominant strain causing 90% of incoming skin and soft tissue infections. The 300 clone gets its name from its identifying markers using pulsed-field molecular epidemiology. Investigators found the strain typically is resistant to beta-lactam drugs and erythromycin but susceptible to clindamycin. Some MRSA isolates that are reported as susceptible to clindamycin and resistant to erythromycin may have inducible resistance to clindamycin. In these cases, additional laboratory testing (the D test) is necessary before treating a serious infection with clindamycin alone.
Transmission prevention
Skin infections with MRSA are transmitted by close skin-to-skin contact with an infected person or contact with objects or surfaces contaminated with MRSA.
Wash hands regularly. Wear gloves when managing wounds. Then remove gloves and wash hands with soap and water. Carefully dispose of dressings. Clean surfaces of exam room and equipment. Linens should be washed in hot water, detergent and bleach and then dried in a hot dryer. Regular trash disposal is effective.
