Recommendations for Treating MRSA

MRSA infections may be better diagnosed with imaging and treated with draining

(RxWiki News) New guidelines just released are suggesting different ways to assess and treat wounds caused by the difficult-to-treat bacteria called MRSA.

Methicillin-resistant Staphylococcus aureus (MRSA) has been around for more than 10 years. It is difficult to eradicate, and often resistant to antibiotic treatment.

Updated "best practice" guidelines for managing the skin abscesses associated with this community-acquired bacteria have been developed by two physicians at Stony Brook University in New York.

The researchers recommended limiting the use of antibiotics in these patients and using imaging techniques to see what is going on in deep wounds. They also suggested ways to avoid ever getting the infection, such as washing hands regularly and trying not to share personal items like towels.

"Don't share personal items like towels and wash hands often."

David Talan, MD, and Adam Singer, MD, are emergency room doctors who have seen a lot of infections over the years. In these guidelines, these doctors made recommendations for treatment of abscesses found on the trunk of the body, or on extremities (arms or legs). They based their recommendations on randomized trials, some small, observational studies and expert opinions.

Abscesses are swollen, red, tender masses on the skin that fluctuate (change position). There is often surrounding inflammation of the skin, called cellulitis. Drs. Talan and Singer recommended draining small abscesses, as has been done in the past. Some abscesses, however, are large or appear differently.

Abscesses may have a hard top, and doctors can now use ultrasound to see if there is fluid beneath the head top of the skin. Ultrasounds allow doctors to get images on what is going on inside the body. Ultrasound can also be used to check that an abscess which has been drained is now dry.

Drs. Talan and Singer wrote that in one study of 126 patients, treatment for 56 percent of patients was changed when ultrasound was used and doctors had more information.

Packing of the wound with sterile gauze, which was often done in the past, may not be necessary, they suggested.

Antibiotics are not routinely recommended now. Instead, antibiotics are recommended for people who keep getting recurrent infections, those with extensive disease, those whose disease has spread rapidly, people with suppressed immune systems and the very young or very old. Even then, a variety of antibiotics may be tried before one works.

MRSA is now resistant to the antibiotics clindamycin (brand name Cleocin) and tetracycline in some communities, the authors wrote.

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

The authors recommended that doctors tell patients to keep an eye out for an infection that is not healing or has recurred. In some cases, physicians may ask patients to return so they can check that the infection has healed.

These recommendations were published March 13 in The New England Journal Of Medicine.

Dr. Talan reported receiving consulting fees and grant support through his institution from Durata (a pharmaceutical company). No other potential conflicts of interest relevant to this article were reported.

Review Date: 
March 13, 2014