Boils
Boils are caused by Staphylococcus aureus bacteria. In a boil, the staph infection spreads deeper and wider, often affecting the skin's sebaceous glands (oil-producing glands) or subcutaneous tissue (deeper tissue under the skin).
An outbreak of Methicillin-resistant Staphylococcus aureus cutaneous infection in a saturation diving facility.
Wang J, Barth S, Richardson M, Corson K, Mader J.
Division of Hyperbaric Medicine and Wound Care, Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, USA.
We present a molecular epidemiological investigation of an outbreak of cutaneous tissue infection, which involved six divers during a 45 day saturation exposure dive. The cutaneous infection manifested as boils, foliculitis and small abscesses involving different body sites, including nose, external ear canal, necks, back, extremities, and buttocks. Staphylococcus aureus was consistently isolated from the skin lesions of affected divers. A study of the antibiogram revealed that all Staphylococcus aureus isolates were uniformly resistant to penicillin, oxacillin and erythromycin, but sensitive to clindamycin, tetracycline, trimethoprim-sulfamethoxazole, rifampin and vancomycin. Molecular typing by pulse field gel electrophoresis (PFGE) demonstrated that all the Methicillin-resistant Staphylococcus aureus (MRSA) isolates had an indistinguishable pulsed field gel electrophoresis pattern. The source of outbreak was identified as a colonized diver (diver D). Personal contact was most likely the mode of transmission among the six divers. Infection with MRSA should be suspected in outbreaks of boils that are not responding to standard antibiotic therapy among healthy divers and their close contacts. To our knowledge, this is the first report of Methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a saturation diving facility.
PMID: 14756230 [PubMed - indexed for MEDLINE]
Community-acquired meticillin-resistant Staphylococcus aureus: an emerging threat.
Zetola N, Francis JS, Nuermberger EL, Bishai WR.
Department of Medicine, Johns Hopkins University, Baltimore, MD 21231-1001, USA.
Community-acquired meticillin-resistant Staphylococcus aureus (MRSA) is becoming an important public-health problem. New strains of S aureus displaying unique combinations of virulence factors and resistance traits have been associated with high morbidity and mortality in the community. Outbreaks of epidemic furunculosis and cases of severe invasive pulmonary infections in young, otherwise healthy people have been particularly noteworthy. We review the characteristics of these new strains of community-acquired MRSA that have contributed to their pathogenicity and discuss new approaches to the diagnosis and management of suspected and confirmed community-acquired MRSA infections.
PMID: 15854883 [PubMed - indexed for MEDLINE]
Recurring methicillin-resistant Staphylococcus aureus infections in a football team.
Nguyen DM, Mascola L, Brancoft E.
Los Angeles County Department of Health Services, Los Angeles, California 90012, USA.
An outbreak of community-associated methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) occurred in a college football team from August to September 2003. Eleven case-players were identified, and boils were the most common sign. Linemen had the highest attack rate (18%). Among 99 (93% of team) players with cultured specimens, 8 (8%) had positive MRSA nasal cultures. All available case-players' MRSA isolates characterized had the community-associated pulsed-field type USA300. A case-control study found that sharing bars of soap and having preexisting cuts or abrasions were associated with infection. A carrier-control study found that having a locker near a teammate with an SSTI, sharing towels, and living on campus were associated with nasal carriage. Successful outbreak control measures included daily hexachlorophene showers and hygiene education.
PMID: 15829189 [PubMed - indexed for MEDLINE]
Staphylococcal skin infections in children : rational drug therapy recommendations.
Ladhani S, Garbash M.
Department of Paediatrics, Newham General Hospital, London, UK.
Staphylococcus aureus remains one of the most common and troublesome of bacteria causing disease in humans, despite the development of effective antibacterials and improvement in hygiene. The organism is responsible for over 70% of all skin and soft tissue infections in children and accounts for up to one-fifth of all visits to pediatric clinics. Skin and soft tissue infections that are predominantly caused by S. aureus include bullous and non-bullous impetigo, folliculitis, furunculosis, carbunculosis, cellulitis, surgical and traumatic wound infections, mastitis, and neonatal omphalitis. Other skin and soft tissue infections may also be caused by S. aureus but are often polymicrobial in origin and require special consideration. These include burns, decubitus ulcers (particularly in the perianal region), puncture wounds of the foot, as well as human and mammalian bites.Treatment of staphylococcal skin infections varies from topical antiseptics to prolonged intravenous antibacterials, depending on severity of the lesions and the health of the child. The treatment of choice for oral antibacterials remains the penicillinase-resistant penicillins such as flucloxacillin. Cefalexin and erythromycin are suitable cost-effective alternatives with broader cover, although care must be taken with the use of macrolides because of development of resistance to multiple families of antibacterials, particularly the lincosamides. Other cephalosporins such as cefadroxil and cefprozil are also effective, can be given once daily and have a better tolerability profile - while azithromycin has a further advantage of a 3-day course. However, all of these agents are more expensive. Although the antibacterials have been given for 10 days in most clinical trials, there is no evidence that this duration is more effective than a 7-day course. In children requiring intravenous therapy, ceftriaxone has a major advantage over other antibacterials such as sulbactam/ampicillin and cefuroxime in that it can be given once daily and may, therefore, be suitable for outpatient treatment of moderate-to-severe skin infections. Newer-generation cephalosporins and loracarbef are also effective and have a broader spectrum of activity, but do not offer any added benefit and are significantly more expensive.Skin and soft tissue infections due to methicillin-resistant S. aureus (MRSA) are still relatively uncommon in children. Well children with community-acquired MRSA infections can be treated with clindamycin or trimethoprim-sulfamethoxazole (cotrimoxazole), but must be observed closely for potentially severe adverse effects. In severe infections, vancomycin remains the treatment of choice, while intravenous teicoplanin and clindamycin are suitable alternatives. Linezolid and quinupristin/dalfopristin are currently showing great promise for the treatment of multi-resistant Gram-positive infections. While the choice of antibacterial is important, supportive management, including removal of any infected foreign bodies, surgical drainage of walled-off lesions, and regular wound cleaning, play a vital role in ensuring cure.
PMID: 15871629 [PubMed - in process]
High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections.
Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F.
Department of Emergency Medicine, Alameda County Medical Center-Highland Campus, Oakland, CA 94602, USA
STUDY OBJECTIVE: We sought to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among emergency department (ED) patients with skin and soft tissue infections, identify demographic and clinical variables associated with MRSA, and characterize MRSA by antimicrobial susceptibility and genotype. METHODS: This was a prospective observational study involving a convenience sample of patients who presented with skin and soft tissue infections to a single urban public hospital ED in California. Nares and infection site cultures were obtained. A health and lifestyle questionnaire was administered, and predictor variables independently associated with MRSA were determined by multivariate logistic regression. All S aureus isolates underwent antibiotic susceptibility testing. Eighty-five MRSA isolates underwent genotyping by pulsed field gel electrophoresis, staphylococcal chromosomal cassette mec (SCC mec ) typing, and testing for Panton-Valentine leukocidin genes. RESULTS: Of 137 subjects, 18% were homeless, 28% injected illicit drugs, 63% presented with a deep or superficial abscess, and 26% required admission for the infection. MRSA was present in 51% of infection site cultures. Of 119 S aureus isolates (from infection site and nares), 89 (75%) were MRSA. Antimicrobial susceptibility among MRSA isolates was trimethoprim/sulfamethoxazole 100%, clindamycin 94%, tetracycline 86%, and levofloxacin 57%. Among predictor variables independently associated with MRSA infection, the strongest was infection type being furuncle (odds ratio 28.6). Seventy-six percent of MRSA cases fit the clinical definition of community associated. Ninety-nine percent of MRSA isolates possessed the SCC mec IV allele (typical of community-associated MRSA), 94.1% possessed Panton-Valentine leukocidin genes, and 87.1% belonged to a single clonal group (ST8:S). CONCLUSION: In this urban ED population, MRSA is a major pathogen in skin and soft tissue infections. Although studies from other practice settings are needed, MRSA should be considered when empiric antibiotic therapy is selected for such infections.
PMID: 15726056 [PubMed - indexed for MEDLINE]
