Management of community-associated methicillin-resistant Staphylococcus aureus skin abscesses in children

Question 1

What are risk factors for spread of CA-MRSA?

Answer 1

1. Close skin-to-skin contact
2. Openings in the skin such as cuts or abrasions
3. Contaminated items and surfaces
4. Crowded living conditions
5. Poor hygiene
6. Aboriginal
7. Athletes
8. Daycare attendees
9. Military recruits
10. IV drug users
11. Men who have sex with men
12. Prisoners

Question 2

What is the management after abscess drained for a child <1mo?

Answer 2

1. Admit for Vancomycin IV (+/- other agent)
2. Clindamycin as outpatient if abscess <1cm, child previously well, no fevers, no signs of systemic illness, parents seem reliable

Question 3

What is the management after abscess drained for a child 1-3mo?

Answer 3

If no fever or other systematic signs of illness then TMP/SMX PO pending cultures

Question 4

What is the management after abscess drained for a child >3mo if low-grade fever (<38 degrees C) or no fever and no systemic signs of illness?

Answer 4

Observe after antibiotics
Only consider antibiotics if the child does not improve or the culture grows and organism other than Staphylococcus aureus

Question 5

What is the management after abscess drained for a child >3mo with significant surrounding cellulitis, low grade or no fever, and no other systemic signs of illness?

Answer 5

IV antibiotics

Question 6

What is the recommended therapy for significant cellulitis with skin abscess?

Answer 6

SMX/TMP with cephalexin to cover GAS