Cellulitis, skin abscesses, and community-acquired methicillin-resistant Staphylococcus aureus

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PURPOSE: To review the clinical features and treatment of common bacterial infections of the skin and soft tissue, the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), and its impact on treatment decisions. EPIDEMIOLOGY: Skin and soft-tissue infections account for about 7% to 10% of hospitalizations in North America, and upwards of 2.5% of primary care office visits. MRSA is a common cause of bacterial infection in hospitals, accounting for 40% to 70% of total S aureus infections. Traditionally a hospital pathogen, MRSA has become increasingly common in community settings. CA-MRSA has been seen both sporadically and in local outbreaks. REVIEW SUMMARY: The increasing prevalence of MRSA has had a considerable impact, however clinicians cannot often reliably anticipate CA-MRSA. CA-MRSA tends to affect children and younger adults with an emphasis on skin and soft-tissue infections whereas hospital-acquired MRSA is more common among the older adult population, typically causing bacteremia and deep infections. The approach to pharmacologic therapy or these infections may require modification of the historical long-term reliance upon β-lactam antibiotics, instead using different drugs while increasing the emphasis upon incision and drainage. TYPE OF AVAILABLE EVIDENCE: Randomized controlled trials, randomized studies, prospective and retrospective cohort studies, unstructured reviews, and conference proceedings/presentation slides. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: Pharmacologic treatment of skin and soft-tissue infections, especially in the community setting, may require consideration of drugs targeting MRSA, though whether this needs to be empiric or based on culture results is subject to debate. Incision and drainage of cutaneous abscesses including culturing of material have become particularly important for proper management.

Original languageEnglish (US)
Pages (from-to)62-70
Number of pages9
JournalAdvanced Studies in Medicine
Issue number2
StatePublished - Feb 2006

ASJC Scopus subject areas

  • General Medicine


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