Methicillin-resistant Staphylococcus aureus (MRSA) infections are difficult to treat because they are resistant to most antibiotics. In addition, the number of these virulent infections has increased dramatically over the last decade. Together with the increase in cases is an increase in skin abscesses, which are collections of pus that accumulates within tissue because of the inflammatory process in response to infections. A new report by UCLA researchers appears in the March 13 edition of The New England Journal of Medicine. It offers updated guidelines that outline the best ways to treat these abscesses. The authors also offer suggestions for the general public that can help reduce acquiring or spreading a skin infection.
The researchers note that first cases of MRSA were relatively mild and primarily affected high-risk patients in hospitals and long-term care facilities. However, beginning in the early 2000s, healthcare professionals identified a new, highly contagious and difficult to treat strain known as “community-acquired” MRSA, which had spread to the general public. This more virulent form of MRSA can be treacherous; it can cause necrotizing pneumonia destruction of ling tissue), fasciitis (infection of the muscle sheaths) and sepsis (infection throughout the body).
Dr. Gregory Moran, Dr. David A. Talan and colleagues at Olive View–UCLA Medical Center published one of the first reports that MRSA infections would become epidemic in The New England Journal of Medicine in 2006 by. The report noted that community-associated MRSA had become the most common cause of skin infection among patients presenting at emergency rooms and other settings in the US. “MRSA is not going away, so we need to fine-tune ways to treat it,” noted Dr. Talan, a professor in the division of infectious diseases and chief of the department of emergency medicine at Olive View–UCLA Medical Center. He added, “We hope the information will help guide doctors as to the best ways to address these infection-related skin abscesses.”
The researchers focused on abscesses that occur on the trunk of the body and the extremities (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 stressing new diagnostic techniques such as ultrasound, guidance for physicians on the most effective antibiotics, and an overview of abscess-draining techniques that are less invasive, painful, and disfiguring than conventional treatments.
In most cases MRSA diagnosis and abscess drainage is straightforward; however, the authors note that technologies such as ultrasound can enhance diagnostic accuracy for abscesses located deep in the lower levels of the skin. Ultrasound is currently available in more emergency departments and hospitals; it can also help ensure that an abscess has been adequately drained. The guidelines note that most abscesses can be drained with a single small incision. They offer 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.
The authors 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 explain that antibiotic treatment is particularly helpful for patients who have risk factors such as recurrent infection, extensive or systemic disease, rapid disease progression, a compromised immune system, or who are either very young or very old.
They caution that the ever-increasing degree of antibiotic resistance may also affect treatment; for example, MRSA has also become resistant to clindamycin and tetracyclines in some communities; thus, they encourage physicians 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,” noted Dr. Talan.
The update also offers strategies for physicians to prevent new infections patients who experience frequent recurrences. Talan and his team are currently designing a large clinical trial that will further investigate optimal antibiotic treatment for MRSA skin infections. Dr. Talin noted, “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.”
The authors note that because MRSA and other types of skin infections can be readily transmitted between individuals, they offer 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.