Methicillin-resistant Staphylococcus aureus, or MRSA, is an increasingly common bacteria infecting skin and soft tissues. It begins as small skin breaks and progress to a lesion resembling a spider bite. The lesion appears as a raised area of the skin with surrounding redness that is warm and tender to touch. Occasionally fluid collects underneath the bump. While some of these infections resolve spontaneously, most require further treatment including antibiotics, drainage of any infectious material and measures to prevent re-infection.
Incision and Drainage
Fluid collections that are palpable and underneath skin lesions should be investigated with an attempted incision and drainage. This can be done in your doctor's office or in the emergency room. Local anesthetic will be administered to the lesion and a needle or scalpel will be inserted into it. The fluid expressed from the lesion will be sent for culture to confirm the presence of MRSA.
Intravenous Antibiotics
For larger lesions or for people with other medical conditions, the addition of antibiotics may be warranted. Patients with constitutional symptoms such as fever, chills, extensive involvement of the skin, or patients with pre-existing medical conditions such as diabetes or immunodeficiency are candidates for in-patient intravenous (IV) antibiotic therapy. Also, patients who fail to improve after oral antibiotics should return to their health care provider for further management with IV antibiotics. These symptoms and conditions may signify a difficult-to-treat infection that should be managed closely in a hospital.
Oral Antibiotics
For smaller lesions, incision and drainage may be both diagnostic and curative. However, oral antibiotics can be added to the treatment regimen prior to receiving final information about the causative bacteria isolated from the lesion. Commonly used oral medications include sulfamethoxazole-trimethoprim (Bactrim) and clindamycin. Antibiotics are generally given for one to two weeks.
References
- CURRENT Diagnosis & Treatment: Emergency Medicine, 6e; "Community Acquired MRSA"; C. Keith Stone, MD et al; February 2007
- IDSA;"Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections"; Dennis Stevens, et al; December 2005
