Selecting a Treatment Regimen
Appendix 1. Conditions in which Antimicrobial Therapy is Recommended After Incision and Drainage of an Abscess Due to CA-MRSA
> Severe or extensive disease (eg, multiple sites) or rapid progression in presence of associated cellulitis
> Signs and symptoms of systemic illness > Associated comorbidities or immunosuppression (diabetes mellitus, HIV/AIDS, neoplasm)
> Extremes of age > Abscess in area difficult to drain completely (eg, face, hand, genitalia) > Associated septic phlebitis > Lack of response to incision and drainage alone
Management of Recurrent MRSA Skin and Soft Tissue Infections
ÎPreventive educational messages on personal hygiene and appropriate wound care are recommended for all patients with SSTI. Instructions should be provided to:
> Keep draining wounds covered with clean, dry bandages (A-III). > Maintain good personal hygiene with regular bathing and cleaning of hands with soap and water or an alcohol-based hand gel, particularly after touching infected skin or item that has directly contacted a draining wound (A-III).
> Avoid reusing or sharing personal items (eg, razors, linens and towels) that have contacted infected skin (A-III).
ÎEnvironmental hygiene measures should be considered in patients with recurrent SSTI in the household/community setting:
> Focus cleaning efforts on high-touch surfaces that may contact bare skin or uncovered infections (C-III).
> Commercially available cleaners or detergents appropriate for the surface being cleaned should be used according to label instructions for routine cleaning of surfaces (C-III).
ÎDecolonization may be considered in selected cases if:
> A patient develops a recurrent SSTI despite optimizing wound care and hygiene measures (C-III).
> Ongoing transmission is occurring among household members or other close contacts despite optimizing wound care and hygiene measures (C-III).
ÎDecolonization strategies should be offered in conjunction with ongoing reinforcement of hygiene measures and may include:
> Nasal decolonization with mupirocin twice daily for 5-10 days (C-III). > Nasal decolonization with mupirocin twice daily for 5-10 days and topical body decolonization regimens with a skin antiseptic solution (eg, chlorhexidine) for 5-14 days or dilute bleach baths (1 teaspoon per gallon of water or 1/4 cup per 1/4 bathtub [or 13 gallons of water] given for 15 minutes twice weekly for ~3 months can be considered) (C-III).
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