FEATURED SEARCH: cellulitis
Another public health scare succumbs to reasoned medical investigation. Reports within the past few months confirm that, although it may be classed as an epidemic, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is coming under control. Observing that antibiotic treatment for diffuse, non-culturable cellulitis had become "broad-spectrum and haphazard," doctors at a UCLA-affiliated county hospital began a prospective investigation in late 2004 using serology to determine the cause of these infections. Three of four traced to beta-hemolytic streptococci as usual, they found, and 96% succumbed to beta-lactam antibiotics. Their report offers a cost-effective algorithm for the management of uncomplicated soft-tissue infections. (There are no guidelines for cellulitis treatment, and a recent review by the Cochrane Collaboration says most recommendations so far are based on single trials like this one.)
RESULT: The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation Medicine (PubMed) | Jul 1, 2010
RESULT: Interventions for cellulitis and erysipelas Cochrane Reviews (PubMed) | May 4, 2010
The NIH is testing various antibiotic regimens for MRSA in two trials, one of which focuses on skin and soft tissue infections (SSTIs) and CA-MRSA. Recruiting in Los Angeles and Chicago, it is testing clindamycin or trimethoprim-sulfamethoxazole against placebo. Results aren't due until 2012.
RESULT: Strategies Using Off-Patent Antibiotics for Methicillin Resistant S. Aureus "STOP MRSA" ClinicalTrials.gov | Jun 24, 2010
RESULT: Uncomplicated Skin and Soft Tissue Infections Caused by Community-Associated Methicillin-Resistant Staphylococcus Aureus ClinicalTrials.gov | Jul 22, 2010
In a clinical review, a Boston University Medical Center pediatrician reports that do far the choice of antibiotic doesn't seem to have much effect on the outcome of CA-MRSA cellulitis, and recommends looking to the profile of antibiotic susceptibility in your own community. In the case of abscesses, she finds, the choice of antibiotic therapy is irrelevant. What matters is the adequacy of drainage.
RESULT: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections Current Opinion in Pediatrics (PubMed) | Jun 1, 2010
As for halting CA-MRSA at the point of entry, a different set of UCLA researchers offers some puzzling information. Their prospective survey of body sites involved in SSTIs shows that the resistant organism is less likely than susceptible S. aureus to enter by the nose. When the CA-MRSA infection does lead to pneumonia, Northwestern University doctors report in a prospective study, it does not necessarily begin with influenza. Their findings are less ominous than some previous studies: The only patients in their series who died from the infection were immunocompromised, and most patients did not need to enter the ICU.
RESULT: Body-site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections Clinical Microbiology and Infection (PubMed) | May 1, 2010
RESULT: Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia Chest (PubMed) | Jul 1, 2010