boils, furuncle and abscesses-skin cultures necessary? most likely MRSA?

[linguine]

Wondering what everyones experiences is on patients who present with boils, furuncles and abscess like formations? Does the provider always culture? How do they decide?

From my own experience and observing those of my patients, I have noticed that some providers do not perform skin cultures (even if the formation is ready to be incision and drained.). They prescribed antibiotics and depending on how large or infected the area looks say "it's most likely MRSA." A lot of times, providers refuse to I&D because of the risk of causing a deeper infection as well.

Other providers say state that we clinically we do not know unless we get a culture so they perform a culture. I could see this benefit public health tracking as well as confirming the right treatment initially prescribed.

Also, it is unsettling to observe that most providers deduce that these skin infections are all infected with MRSA (whether its HA-MRSA or CA-MRSA). I work in a clinic and more cases of suspected MRSA are coming up in younger patients who have never worked in health care nor been patients in the hospital. Many times, the cultures do come back +. It is frightening. A while ago, I started a post on the future of nursing. I think in our future in nursing will reach a peak of technology and skill set.. then go back to the basic: infection control. Extreme diligence on the part of individuals and communities will be necessary to prevent spread of disease infection control more than today due to the increasing population, crowded spaces, difficulty accessing health care (debatable) and simultaneously, increased traffic flow through outpatient centers and ERs.

[nerdtonurse?, BSN, RN]

Not every infection is MRSA/ORSA. People have had carbuncles and "zits" for centuries.

However, I do think that instead of putting the MRSA + people in isolation 10 years from now, we're going to be isolating the MRSA negative. I think we are seeing the migration of MRSA from a rare bacteria to a "normal" bacteria found on the skin of the majority of the population. Just my 2 cents...

[Altra, BSN, RN]

Agree - MRSA is here to stay and I know of hospitals that don't even use contact isolation for MRSA+ patients anymore unless there is a current, active infection.

Staph bacteria are endemic to most environments.

[linguine]

How will we practice to prevent inactive MRSA colonizations from becoming active and causing severe illness?

This discussion reminds me Tuberculosis.... many are latent, but when it becomes active, it is a serious life threatening illness. Tuberculosis strains are also developing resistance to antibiotics now. For patients with latent TB infections, we advise: good hygiene, good nutrition and clean living conditions.

With tuberculosis, a latent infection is very difficult, if at all possible, to pass to others. However, with MRSA colonization, it is easier for individuals to pass colonization even if the person is not having active infection. The recipient will become colonized and if immunocompromised at some point (perhaps even from a bad case of flu), can turn into an active infection.

[lckrn2pa]

The reason your provider is diagnosing MRSA is based on probability of the community. If your in a community where MRSA is prevalent then you treat it as MRSA. I&D is the preferred treatment of an abscess if it is fluctuant or "ripe", if not then warm compresses and po antibiotics is the treatment. Now as far as your question on the population of cases, they don't have to be in a hospital to acquire this. Younger patients, such as high school age can pick this up at the gym and that goes for anybody that goes to any gym and uses their equipment. If you don't spray it off before and after then the risk is there to pick this up. MRSA is out there in the community not just in our workplace.

[VickyRN, MSN, DNP, RN]

At my secondary employer (a small community hospital ER), most suspicious lesions are treated as if they are CA-MRSA and not cultured. Appropriate PO antibiotics are prescribed. It simply takes too long for the cultures to come back and the ER is meant only to "treat and street."

[pedicurn, LPN, RN]

I've seen quite a few younger p'ts with multiple boils /abscesses - they nearly always test MRSA +

These p'ts are often young adults who have fairly unhealthy lifestyles - commonly obese with takeaway diet /smokers/drinkers.

Also notice their personal hygiene is often mediocre ...not obviously filthy but come in with grimey collars and the same jeans they have worn for the last 2/52

[lifelearningrn, BSN, RN]

Isn't treating it as if it were MRSA without really knowing for sure compounding the problem? Treating an infection that can easily be cured with a basic penicillin with something stronger just weakens the potential use for that antibiotic in the future. We already have VRSA... soon bacteria are going to bring us back into the dark ages...

[FrogKissingNurse]

about 7 years back i suffered from recurrent boils all over my legs. i went to the dermatologist and my primary care physician. the dermatologist called it foliculitis and gave me creams to put on it. the primary care doc wasn't sure what to do with me. this was back when mrsa was just being discovered and it was all over the news about killing kids in a few days with the infection. anyways i finally found a physician that called it mrsa infections and gave me a cocktail of medications and creams. i haven't had any troubles since then.

i have no idea how i got it, no one else that i was around was having any issues with it. i was totally miserable though and refused to wear shorts that summer because my legs looked horrible!

[classicdame, MSN, EdD]

the answer to the original question depends on so many things, like co-morbities, patient moblility, as well as environment. We prefer our nurses call in the infection control nurse for consulation. He then consults with MD if needed.

[Jonathank]

The irony of this is, it's years and years of antibiotic-happy docs and patients that have led to the emergence of superbugs like MRSA. I don't have any easy answers, but treating resistant microbes with a cocktail of antibiotics amounts to kicking the can down the road, IMHO.

[lifelearningrn, BSN, RN]

Bacteria are actually quite amazing in their ability to adapt, pass their DNA (especially their resistant genes) to others, and survive. They are growing resistant faster than we can find new drugs to battle them. It's scary, it really is.