More MRSA
Saturday, June 27, 2009
Paul Auerbach, M.D.
"Community acquired" (that is, not acquired in the hospital, which would be "hospital acquired") methicillin-resistant Staphylococcus aureus (MRSA) infections have not likely come about because germs that have evolved bacterial resistance by residing within hospitals have spread into the community. Rather, this bacterial resistance to methicillin appears to have arisen independently. The "community" now absolutely needs to be considered to include the outdoor community. Hikers, kayakers, divers, climbers and all other outdoors persons who share equipment or mingle with the general population are susceptible. From a reference entitled "Diagnosis MRSA - The Clinical Challenge of Multidrug-Resistant Infections," authored by Peter DeBlieux and colleagues and published as a supplement to ACEP NEWS, comes some useful observations.Skin and soft tissue infections are among the most common infections caused by bacteria that can develop resistance to bacteria. Persons at particular risk for such infections include males, certain geographies, time of year (during warmer months), and affliction with diabetes. Many of the infections are abscesses, in which there is a pus pocket that can be drained by making an incision. Such treatment is in fact important to help control the spread of MRSA infections, presumably by helping to cure the abscess(es).
The current thinking is that in the setting of an "uncomplicated" skin and soft tissue infection (e.g., no involvement of deep tissues, minor clinically: simple abscess, impetigo, pimple, or superficial cellulitis), incision and drainage of small, localized abscesses can be curative. However, this is not an absolute, so many physicians are of the opinion that adding an effective antibiotic is useful. Until we have more information, it remains the clinical judgment of the treating physician about whether or not to prescribe an effective antibiotic, such as trimethoprim-sulfamethoxazole.
In complicated infections, which involve deeper skin structures (such as infected tissue ulcers, rapidly progressive infections, diabetic foot infections involving MRSA), antibiotics are deemed to be essential. The oral antibiotics that are felt to be effective against MRSA are clindamycin, trimethoprim-sulfamethoxazole, doxycycline, minocycline, linezolid, and rifampin. The injectable antibiotics that are felt to be effective against MRSA are vancomycin, clindamycin, daptomycin, tigecycline, linezolid, and quinupristin-dalfopristin. Notably, the fluroquinolone category of drugs, which includes ciprofloxacin, is not recommended as an effective treatment for community acquired MRSA infection. The same holds true for the macrolide category, which includes erythromycin, as well as cephalexin, penicillin, and dicloxacillin.
To prevent the spread of MRSA, wounds should be kept covered with clean, dry bandages; hands washed with soap and water or an effective hand sanitizer after each dressing change; close contacts instructed to bathe regularly; no sharing be allowed of bedding, towels, washcloths, bar soap, razors, and so forth.
image courtesy of www.mrsatreatments.com
Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.
Tags: MRSA, Staphylococcus aureus, infection, wilderness medicine, outdoor medicine, healthline
4 Comments:
At Mon Jun 29, 03:01:00 AM 2009,
david Smith said…
Nice info. I was looking for some thing else. But this is also usefulADD/ADHD
At Sun Jul 05, 12:54:00 PM 2009,
Anonymous said…
I had M.R.S.A. pop up on me seven times within a fourteen month period. My Dr. always put me on clindamycin and rifampin. It would go away for 6 weeks or so, and then come back. I finally went to a hospital the last time that I had it, and they gave me the IV drip of vancomycin. I went in for 3 days in a row for the drip, that along with the clindamycin has seemed to cure it. It is now July 5th, 2009 and I haven't had it since Oct. '08. All blood tests still show negative.
At Mon Jul 06, 10:34:00 AM 2009,
Anonymous said…
i donot know if any one has ever tried the role of gentle pressure& massage at & around the site of wounds along with raising of the affected part. i have been able to heel deep incised wounds of finger within twelve hours by just applying pressure on the site for just 10 sec every 2hrs for 1st 6hrs. this was as i didnot allow any serum or blood to accumulate at the site. so there was no media on which germs could grow. 2ndly since neither blood nor serum accumulated at the site, there was nothing that could block the flow in the fine thin capillaries, which carries the healing factors to the site.
gentle massage around the site along with raising the part helps in draining the accumulated exudate at the site& thus helping in increasing the capillary circulatoion at the site which is very essntial in bringing the various heeling factors present in the blood.even the antibiotics taken orally or by injections can reach the site only if the capillaries are patent ie not compreessed by the surronding exudative fluid. i stongly recommend raising of part, gentle massage of the part& gentle pressure on the site. even massive burns wound can easily recover by above measures
At Fri Aug 21, 10:07:00 AM 2009,
jmgalvez said…
My 12-year-old son had 4 MRSA infected bumps on the back of his thighs. We thought they were spider bites from the cabin. He got them during a white water rafting trip at the American River in July.
We started treating each site with tea tree oil every hour, and then when it became clear that the infections continued to grow, we started lancing and draining and treating with tea tree oil. We added oregano oil - which really seemed to make some progress - and sitz baths. It looked as though we had beaten it, but we went to the doctor just in case. He prescribed an antibiotic for skin ailments because we truly thought it was spider bites.
Almost immediately after starting the antibiotic, the infections took a sharp turn to the worse. Giant pea-sized pustules were coming out of the infections. One morning he woke up and his sheets were covered in puss and blood. Every time the wounds (from lancing) would close, they would get worse and more painful.
We finally went to the emergency room. The attending physician gave him 4-6 shots (painful) of lidacaine into each wound. Then she surgically lanced and drained each infection again and remarked that we had gotten most of the infection out ourselves. But more importantly, she was able to put antibiotic/antiseptic deeper into each wound. She stuffed each wound with gause attached to a thin paper-like wick, and explained that the wick would keep the wound from closing and let the infection drain out. She covered each infection, and gave us a very powerful antibiotic.
Three days later, the doctor called and said that the culture from the ER came back and that my son had MRSA!! It wasn't spider bites after all.
I looked at MRSA images all over the web and saw that they looked exactly like what my son had.
Almost one month later, his skin is completely flat and only purpleish/pink where the incisions were made to drain his wounds.
But our doctor has warned that anyone in our household have to tell physicians at the hospital or dr's office that we have a family member with MRSA. And we should take care with lung infections which could lead to pneumonia and any other rash or skin infection.
So - my advice to you - get any infected wounds CULTURED immediately. Always drain any infection yourself or at the hospital or doctor's office. Infections are bad. Tea tree oil and oregano oil are excellent antiseptics and didn't hurt when applied to wounds. Wash hands thoroughly after lancing/draining. Drain onto clean tissue paper & throw away in a safe place.
Post a Comment
<< Home