Community-associated methicillin-resistant Staphylococcus aureus: reconsideration of therapeutic options

Prevention of Recurrent Staphylococcal Skin Infections

Staphylococcus aureus infections pose a significant health burden. The emergence of community-associated methicillin-resistant S aureus has resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S aureus colonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S aureus infections often cluster within households, and asymptomatic carriers serve as reservoirs for transmission; therefore, a household approach to decolonization is more effective than measures performed by individuals alone. Novel strategies for the prevention of recurrent SSTI are needed.

Cutaneous abscesses in children: epidemiology in the era of methicillin-resistant Staphylococcus aureus in a pediatric emergency department

OBJECTIVE

Skin and soft tissue infections are a major public health issue. Previous literature suggests a recurrence rate of 4% in children. The purpose of this study was to examine the epidemiology, body location, and history of previous infections among children in the emergency department setting.

METHODS

A retrospective study was performed using electronic medical records from all subjects treated in a large pediatric emergency department with attending physician diagnosis and billing codes indicative of a cutaneous abscess from July 1, 2007, to December 31, 2007. Descriptive statistics were used to evaluate abscess location, prior history of infection, bacterial etiology, and patient disposition.

RESULTS

Three hundred eighteen abscess visits occurred in 308 individual subjects; 79% were due to methicillin-resistant Staphylococcus aureus. Approximately 14% of subjects presented with more than 1 abscess. Those 2 years or younger were more likely to have buttock abscesses (P < 0.001). Of the 192 subjects for whom responses were documented, 82 (43%) had a history of a prior abscess. Children 2 years or younger were significantly more likely to be hospitalized or go to the operating room: 49% versus 15% (P < 0.001).

CONCLUSIONS

Many children with a cutaneous abscess have a prior history of infection. Multiple abscesses are common. Young children are more likely to have abscesses in the diaper area or be hospitalized. Studies of effective hygiene practices and interventions to reduce recurrence are urgently needed.

The critically ill patient and regional anesthesia

PURPOSE OF REVIEW

The review presents an overview of indications, limitations and practical aspects of regional anesthesia and analgesia in critically ill medical and surgical patients.

RECENT FINDINGS

A Medline search from 1966 to 2006 with the search terms regional anesthesia, regional analgesia, critically ill and nerve blocks, as well as a search of the Cochrane Library, revealed no studies specifically designed to evaluate the use of regional anesthesia and analgesia in the intensive care unit setting. The available evidence is limited to case reports, cohort studies and expert opinions, and relies heavily on extrapolation from studies primarily designed to examine intraoperative management of surgical patients in whom an intensive care unit admission was part of the perioperative course.

SUMMARY

Regional anesthesia and analgesia in the critically ill can help to improve respiratory function, bowel function, mental status and patient comfort secondary to its opioid-sparing effects. Limitations for the use of regional anesthetic techniques are mainly associated with bleeding risks, hemodynamic side-effects, difficulties in neurologic assessment and the potential of local anesthetic toxicity.

Emerging Infections in Dermatology

Cutaneous infections are common in dermatology. They occur in all populations and all ages. This review will focus on 3 emerging infections encountered by dermatologists; community-acquired methicillin-resistant Staphylococcus aureus, Epstein-Barr virus infections, and the atypical mycobacterial infections. The background, clinical presentation, diagnosis, and treatment of each of the 3 infections will be discussed.