[Marie_LPN, RN]

In this area, we seen a large amt. of I and D pts. coming from one particular county. Different bacterial cultures though.

And lack of good hygiene has been a factor as well.,

[Graciegirlienurse]

The friend with the infection in his armpit should have been started on abx right away!

A good sign that it is mrsa is when it goes from bad to unbearable in 24-48 hours. both of my lesions started as small bumps and doubled or tripled in size every 12-24 hours. Both times the doc put me on broad spectrum abx asap, and then changed the med later when the cultures returned. different strains can be resistant to more than just the methicillin.

[LeahJet]

Originally Posted by Graciegirlienurse

It is not just poor, fat, and dirty people who get mrsa. Consider that the poor people are presenting to the er because they do not have the resources to be seen in a doctors office(where I was treated)

Oh, I totally agree with you....I said in an earlier post that we are seeing them from all walks of life. I also pointed out that the reason we are seeing the lower socio-economic group is due to lack of insurance/mindset.

And thanks for the links.... very informative.

[Gompers]

Originally Posted by Graciegirlienurse

The friend with the infection in his armpit should have been started on abx right away!

A good sign that it is mrsa is when it goes from bad to unbearable in 24-48 hours. both of my lesions started as small bumps and doubled or tripled in size every 12-24 hours. Both times the doc put me on broad spectrum abx asap, and then changed the med later when the cultures returned. different strains can be resistant to more than just the methicillin.

That's another reason I think it actually was MRSA that my friend had. They just told him staph, put him on an oral antibiotic (the second time, not the first) and that was it. Personally, I think the first time he should have had IV fluid, IV antibiotics, and IV pain meds while in the ER. He came there first thing in the morning, was there for six hours, had nothing to eat or drink, and from what he told me, he sounded a bit shocky. First of all, they didn't even medicate him at all for pain. They were going to use a local, but the doc said that because the lesions were so deep, lidocaine wouldn't help much. So he used NOTHING while he dug around my poor friends lesions for over an hour. The nurse came in at one point, asked the doc if he wanted her to mix up a bag of *something my friend couldn't remember, wasn't vanco, but sounded like an antibiotic to him* and the doc said, no, he doesn't need that, and he doesn't have an IV either. The nurse looked shocked at that, my friend said, like she couldn't believe that he didn't have an IV and that the doc didn't want whatever med she mentioned.

[danfif]

I think what we are seeing is an increase in different bacterial strains that are becoming more aggressive in our society, whether it is in the poor section or in the areas of more money. I work in an inner city ER, and I would venture to guess that in a 24 hr period that we have 15 to 20 patients present with so-called "spider bites".

Yes, the large majority are of lower income levels, and not the cleanest people in the world. And yes some are drug users, but, having talked with a Doc at one of the suburban ER's he tells me that they have seen a huge up swing in the amount of abcesses over the past year, and these folks sure are not poor, and unclean. So to catagorize a lower socioeconomic level as being the cause is inaccurate in my opinion. I think that there is more to it than that. Just what it is though I am not sure.

[Gompers]

Originally Posted by danfif

I think what we are seeing is an increase in different bacterial strains that are becoming more aggressive in our society, whether it is in the poor section or in the areas of more money. I work in an inner city ER, and I would venture to guess that in a 24 hr period that we have 15 to 20 patients present with so-called "spider bites".

Yes, the large majority are of lower income levels, and not the cleanest people in the world. And yes some are drug users, but, having talked with a Doc at one of the suburban ER's he tells me that they have seen a huge up swing in the amount of abcesses over the past year, and these folks sure are not poor, and unclean. So to catagorize a lower socioeconomic level as being the cause is inaccurate in my opinion. I think that there is more to it than that. Just what it is though I am not sure.

You know, I'm so glad this thread was started. My friend has been so down, wondering "Why me? Why all of a sudden?" because he's never had this problem before, ever. I'll let him know that he's not alone, that many other people are experiencing the same thing he is. If it continues, I think I'll tell him to go to his normal doc and ask to be swabbed for MRSA. Do you think, if he is indeed positive, that a course of nasal Bactroban might cure him of these abcesses? Also, I think he is borderline diabetic and from what I understand, these wounds are more common in diabetics. See, they did a blood sugar on him when he was in the ER, and he hadn't eaten in over 12 hours at that point - it was 145. He's also been overweight, often obese, for his whole life, and he's 28 years old. I think he really needs a visit to his regular doc for a full work-up, no?

[all4schwa]

There are definetly increased skin infections among meth users, but I'm not sure why, if someone could clear that up for me, that would be great.
Obese people seem to have more skin infections d/t the decreased vascularity of adipose tissue which prevents the body from clearing bacterial invasions.
I am obese and was having what I call 'boils' on my butt. Upon research I found that it is common for people (not just obese) to carry resident staph in that region. I completely agree with the idea that people overkill on anti-bacterial; however, to prevent reoccurences (easier than the treatment), I keep a bar of Dial in the shower just for the crack of my rear. No more problems there.

[danfif]

Gompers,
Reassure your friend that he is not alone in this area. People from all ecomomic levels are coming up with this type of condition, not just the poor, unclean, and drug abusers.

You are also correct in the fact that Diabetic and over weight patients have a greater tendency to have these types of problems, due to circulation problems. And these patients are at greater risk for other complications as you might suspect. But, it is not just these types that are being seen. I have seen a good number of otherwise healthy 30 something ladies and gentelmen come into my ER with abcesses the size of Texas on all different areas of their bodies, from their face to their foot. You name the anatomical location, and I bet that I have seen it there.

It would be my suggestion for your friend to contact his own doctor, and attempt to get a referal to an infectious disease Doc and have it checked out further to see what strain of bacteria is causing his problems, and to see if the antibiotic that he is taking is the correct one for the cause of his problems.

Just as a point of refference, the majority of our patients are treated with oral antibiotics, namely Bactrim DS. Some will recieve Clyndamycin IV, but that is the exception, and not the rule. Most of the time we just treat'em and street'em. Have them come back in 2 days for a wound check, repack them if needed, then see them in 2 more days. I am not saying that this is the best way to do it, but it is the way it is done here, and from what I have seen, the results have been fairly good.

Hope your friend gets better!
Dan

[paphgrl]

What is I & D?
sorry

[hollykate]

Incision and Drainage.