Tx Guidelines for MRSA Skin Infections

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Cases of skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have increased greatly since the early 2000s. Skin abscesses such pus-filled boils or pimples with discharge characterize these infections, according to a March 12^th 2014 release from the University of California, Los Angeles written by Rachel Champeau. She reports the more virulent form of the infection can result in potentially lethal conditions including necrotizing pneumonia, fasciitis, and sepsis.

In a paper published March 13^th 2014 in the New England Journal of Medicine, Dr. David A. Talan of UCLA and Dr. Adam J. Singer of Stony Brook University in New York offer updated "best practice" guidelines for managing the skin abscesses associated with community-acquired MRSA.

Champeau’s release quotes Dr. Talan as saying, "MRSA is not going away, so we need to fine-tune ways to treat it. We hope the information will help guide doctors as to the best ways to address these infection-related skin abscesses."

For the article, Talan and Singer, both of whom are on the front lines of treating MRSA, focused on abscesses that occur on the trunk of the body and the extremities, such as the arms and legs, which are often treated by general practitioners or emergency room physicians.  

The doctors reviewed prior studies and provided their expert opinions. Highlights of their clinical update include an emphasis on new diagnostic techniques such as ultrasound, guidance for doctors on the most effective antibiotics, and an overview of abscess-draining techniques that are less invasive, painful, and disfiguring than conventional methods.

While in most cases MRSA diagnosis and abscess drainage is straightforward, the authors note that technologies such as ultrasound can enhance diagnostic accuracy for abscesses located deep in the lower levels of the skin. Ultrasound, which is now available in more emergency departments and hospitals, can also help ensure that an abscess has been adequately drained.

Still, most abscesses can be drained with a single small incision, the authors say. In their paper, they discuss techniques for closing drainage incisions and note that the conventional method of packing a wound with sterile gauze to help absorb excess fluid may not always be necessary.

Talan and Singer concur with the Infectious Diseases Society of America that when simply draining an abscess is not enough to address a community-acquired MRSA infection, preferred antibiotics include trimethoprim-sulfamethoxazole, doxycycline, minocylcine and clindamycin.

They note that antibiotic treatment is especially helpful for patients who have risk factors such as recurrent infection, extensive or systemic disease, rapid disease progression, a suppressed immune system, or who are either very young or very old.

But growing antibiotic resistance may also impact treatment, they warn, noting that MRSA has also become resistant to clindamycin and tetracyclines in some communities. The authors encourage doctors to be aware of local susceptibility patterns.

"Even with optimal treatments, there is still a relatively high failure rate in treating these infections, so good patient education on the signs to watch for and availability of close medical follow-up is always recommended," Talan said.

The update also provides doctors with strategies to prevent new infections in some patients who are burdened with frequent recurrences.

Talan and his team are currently working on a large clinical trial that will further investigate optimal antibiotic treatment for MRSA skin infections.

"If you see a skin infection beginning, you should see your doctor right away so that a little problem does not become a bigger one and more difficult to treat," he said.

Because MRSA and other types of skin infections can be easily transmitted between people, Talan offers the following prevention guidance:

*People with skin infections should be careful to keep lesions covered with a dressing or band aid and wash their hands thoroughly after changing the bandage. Place bandages in the trash.

*Avoid sharing personal items such as towels, razors or brushes with people who have an active skin infection.