Use a low threshold for obtaining cultures CA-MRSA sometimes presents as an edematous, tender abscess, an expanding cellulitis, or both.9,10 These presentations, however, are neither sensitive nor specific. Cutaneous infection may also present as erythematous papules, nodules, pustules, crusted plaques, and infrequently suppurative folliculitis.3,10 Therefore, the clinician should have a low threshold to perform bacterial culture and sensitivity studies whenever a skin and soft tissue infection is suspected.
The potential complications of CA-MRSA infection, including pneumonia, sepsis, and endocarditis, can be avoided or minimized with early diagnosis and initiation of appropriate treatment.4,11,12
Consider community factors
In the past, folliculitis and other localized skin infections were traditionally caused by methicillin-susceptible Staphylococcus aureus and treated with beta-lactam antibiotics. In communities with high prevalence of CA-MRSA skin and soft tissue infections, beta-lactam antibiotics like cephalexin or dicloxacillin may no longer be appropriate.2,5 Therefore, let the prevalence of CA-MRSA in your community help guide your initial antibiotic choice while recognizing that empiric antibiotic therapy may be adjusted after cultures are available.
Good initial choices for CA-MRSA skin and soft tissue infections are trim-ethoprim/sulfamethoxazole with or without rifampin, clindamycin, gentamicin, and tetracycline,2,4,5,7 but inducible clindamycin resistance has been reported.13 if your community has a high prevalence of CA-MRSA, you may decide to begin empiric therapy that provides MRSA coverage.2 In addition, incision and drainage is necessary for adequate treatment of furuncles, carbuncles, and abscesses.5 Healthy, afebrile, immunocompetent patients without cellulitis may not require systemic antibiotics to clear local infections.2,4