Skin Infection / Cellulitis + MRSA

A patient of mine last week made me think of my own personal experience in 2005 with “MRSA,” so I thought I’d type about cellulitis today.

Having once been a teen age male I thought I was quite familiar with skin infections ranging from pimples, to carbuncles, to athletes foot, to jock itch. But in 2005 I upped my game. Initially I noticed a bump on my chin that felt like a familiarly annoying pimple that could blossom into an abscess. (Probably shouldn’t have stretched that razor for 3 months.)

The swelling got worse, but the pain was above and beyond any I’d felt before. I tried to lance it, but no luck. I treated myself with Keflex, but nothing. Tried clindamycin + Keflex, but the infection spread even further. A colleague a few years prior needed grafting of his arm after contracting “necrotizing fasciitis,” which we associate with the phrase “pain out of proportion to exam,” so I started to panic.

Finally I used Bactrim and then noticed improvement that very same day, though by now my chin was swiss cheese from all my failed attempts at drainage.

MRSA is no joke and if you want more info listen to this episode of Radio Lab called “Staph Retreat.”

Red Flags:

• Fevers
• Exquisite pain
• Red streaks
• Swollen lymph nodes
• Altered mentation
• IV drug use
• Endocarditis
• Diabetes
• Immunocompromised (AIDS, Hep C, cancer, chronic steroid use, etc.)
• Frail/elderly
• Neonatal
• Rapid onset and rapid progression
• “I work in an ER.”
• “I work at the jail.”
• “My spouse has MRSA.”

Happy Words

• Non painful
• Small area of redness
• Better with elevation
• Similar to past episodes that improved with Keflex

Cellulitis is infection of the skin most often caused by Staph or Strep. When penicillin first arrived it was an incredibly effective miracle drug. But over time Staph in particular has developed resistance. “Methicillin Resistant Staph Aureus” isn’t one particular superbug. It just describes a feature of the Staph Aureus that may be causing an infection. It’s like saying “blue eyed Staph Aureus.”

In other words, your brand of Staph cellulitus may be resistant to clindamycin, while someone else’s may be resistant to Keflex and/or Bactrim, and someone else’s may be only sensitive to IV antibiotics such as vancomycin.

This brings us back to Pre-R. Today patients who are resistant to multiple antibiotics periodically receive IV vancomycin in the ER. They are then instructed to return day after day until their wound cultures demonstrate their sensitivity and resistance patterns. Sometimes the patients are admitted for nothing more than twice daily IV vancomycin dosing.

This to me is crazy, both for patients and for public health. Patients are charged hospital admission fees, basically to sit with their wounds elevated in beds, with IVs dripping, while playing on their iPads. To invite these resistant bacteria into hospitals to be around other fragile patients is ludicrous.

As such Pre-R now offers home vancomycin IV treatment. I know vancomycin resistance is increasing as well, and I really don’t want to be speeding that along with my own practice. But killing MRSA at home is just far more logical.

More pain, less pus… Think MRSA.

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