A 39-year-old man with a skin infection.
The case of Mr M, a previously healthy 39-year-old man with erythema and swelling of his finger, illustrates the issues involved in treating community-acquired skin and soft tissue infections since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community. Most community-acquired infections of the skin and soft tissues are caused by S aureus or Streptococcus pyogenes. Until recently, infections due to such organisms in the United States could safely be treated with an oral antistaphylococcal penicillin or an oral first-generation cephalosporin. However, the emergence of methicillin-resistant staphylococci as community-acquired pathogens has changed the picture as far as empirical therapy is concerned. Not only do community-acquired MRSA bacteria cause furunculitis and cellulitis, they have also been involved in a variety of more serious and life-threatening infections. Most of these organisms are susceptible to trimethoprim-sulfamethoxazole, minocycline, doxycycline, and rifampin, and these agents, along with clindamycin, have been used in the therapy of such infections, even though no clinical trials have proven their efficacy. For more serious, life-threatening infections, linezolid or parenteral agents such as vancomycin or daptomycin should be considered.
Beth Israel Deaconess Medical Center, Department of Medicine, 110 Francis St, Ste 6A, Boston, MA 02215. rmoeller@bidmc.harvard.edu.
Robert C
RC
Moellering
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002481:Cellulitis / Q000382:microbiology* / Q000628:therapy*; D017714:Community-Acquired Infections; D004322:Drainage; D024881:Drug Resistance, Bacterial; D004890:Erythema; D006801:Humans; D007249:Inflammation; D007262:Infusions, Intravenous; D008297:Male; D016106:Methicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000628:therapy*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D010406:Penicillins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination