CA-MRSA skin Abscesses Flashcards
Are there specific parts of the body more commonly associate with CA-MRSA abscesses?
Buttocks and lower limbs
Is it possible to distinguish MRSA from MSSA clinically?
No.
The only way to readily identify MRSA is from a swab from the pus
What are the risk factors for increased spread of CA-MRSA in families?
(4)
Close skin-to-skin contact
Opening of skin with cuts or abrasions
Crowded living
Poor hygiene
Which population is associated with increased clusters?
7
Aboriginal IVDU athletes Men who have sex with men Prisoners Military Daycare attendants
Apart from skin abscesses and cellulitis, what are some other clinical presentations of CA-MRSA?
(4)
Necrotising fasciitis
Pneumonia
Septic arthritis
Osteomyelitis
Do CA-MRSA abscesses progress to NF, septic arthritis, sepsis and pneumonia?
There was concern that if antibiotics were not used, they would progress. But in an RCT there was no evidence of this.
What is the initial management of CA-MRSA abscess?
Initial management is drainage.
Follow up for development of systemic symptoms, worsening local symptoms and no improvement at 48 hours.
There were thoughts that the kids would require ABx but in an RCT there were no increased rates of complications or progression with incision alone. In this RCT, the incision arm had higher recurrence at 10 days but not at 30 days.
Who gets antibiotics?
(3)
Which antibiotic is usually used?
Kids < 1m. IV Vanco or PO clinda
1-3m PO septrA
Cellulitis septra or keflex
Which kids MUST be admitted? What antibiotic would you use?
Kids < 1 month. They get Vanco. If it’s tiny you can do outpatient clinda
Unwell
What are the concerns about using septra? (3)
Are there any other options? (3)
Poor penetration into pus, lungs and thick walled abscess
Staph aureus - can produce thymidine that deactivates the drug
Poor coverage of GAS - although rarely causes abscesses and if it does the abscesses usually resolves after drainage
Other options: doxycycline (needs to be older than 8) and Clindamycin (but the suspension is unpalatable, some resistance, and Cdif) and linezolide (toooooo expensive)
Which kids would you think about covering for GAS?
Those with significant surrounding cellulitis
You can treat with cephalexin and septra before cultures are available
Should you decolonize a family?
No because failure is very common
Is there an age group more at risk of CA-MRSA?
A geographical area?
Children of all ages,including neonates
It occurs all across Canada
