CA-MRSA infections are distinguished from hospital-acquired MRSA infections when the patient with MRSA meets the following criteria:
1.Diagnosis of MRSA was made in the outpatient setting or by a culture positive for MRSA within 48 hours after admission to the hospital (although other time periods have also been used in the literature). 2.The patient has no past medical history of MRSA infection or colonization. 3.The patient has no medical history in the past year of: · Hospitalization · Admission to a nursing home, skilled nursing facility, or hospice · Dialysis · Surgery · Permanent indwelling catheters or percutaneous medical devices 4.The patient has no permanent indwelling catheters or percutaneous medical devices.
MRSA skin infections may present in a number of forms: ·Cellulitis – Inflammation of the skin ·Impetigo – Bullous (blistered) lesions or abraded skin with honey-colored crust ·Folliculitis – Infection of hair follicle (like a pimple) ·Furunculosis – Deeper infection below hair line Carbuncle – Multiple adjacent hair follicles and substructures are affected ·Abscess – Pus-filled mass below skin structures ·Infected laceration – Pre-existing cut that has become infected Other manifestations (i.e. blood, bone or joint infections) are less common, but some patients have required hospitalization for debridement or intravenous antibiotics. Some MRSA skin lesions have been initially misdiagnosed as “spider bites” although verified spider bites are extremely rare and medically significant spiders are uncommon in Southern California.
Risk factors for CA-MRSA skin infection include exposure to jails or prisons; occupations or recreational activities with regular skin-to-skin contact (i.e. wrestling); exposure to someone with MRSA or prior incarceration; exposure to antibiotics; recurrent skin infections; and living in crowded settings.
Culture of skin lesions is especially useful in recurrent or persistent cases of skin infection, in cases of antibiotic failure, and in cases that present with advanced or aggressive infections. When antibiotic therapy is deemed necessary, microbiologic culture should be used as a guide to appropriate antibiotic selection in order to avoid increased drug resistance. In the absence of symptomatic infection, screening for MRSA colonization by culture is generally not necessary unless for infection control or epidemiologic purposes.
Treatment 1.At this time, expert consensus recommendations for the management of community-acquired MRSA infections are not yet available.