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Self-Assessment Questions

Infectious Diseases

Answer 1
  1. Perform incision and drainage, obtain cultures, and prescribe oral clindamycin. Patients with skin and soft tissue infections due to the newly recognized community-acquired MRSA (CA-MRSA) strains often report lesions that resemble spider bites.1 The presence of these lesions along with the patient’s age and health status represent the classic presentation of CA-MRSA skin/soft tissue infection.1 Given the clinical features of this patient’s carbuncle, drainage is the most important first step followed by obtaining cultures to verify the organism causing the infection. Although the current approach to treating patients with suspected S. aureus-infected carbuncles includes drainage, local wound care, and ß-lactam antibiotics (eg, cefalexin, amoxicillin clavulanate), CA-MRSA should be taken into account and physicians should be mindful that certain antibiotics will not be effective for treating these infections.2 Because the patient has a carbuncle that resembles a spider bite with associated cellulitis, oral antibiotics that may have activity against CA-MRSA should be initiated (eg, TMP/SMX, doxycycline, minocycline, clindamycin) instead of empiric ß-lactam therapy. At this point, the patient is not systemically ill and does not require IV antibiotics.

    1. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976-84.

    2. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436-44.

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