I&D and MRSA

[JDCitizen]

i get to take care of a fairly large amount of mrsa and i&d's. the nurses prefer to have me do the i&ds and such with them over the doctors; thus i do have a substantial amount of antibiotic orders. well today i had a little chat with one of the doctors who wants me to cut down on the antibiotics. a large chunk of these i&ds require packing afterward (yep even after years of teaching lots of folks still let it get that bad). this is from the same doctor that wants to do nasal pcr testing on all patients that have i&ds and if positive do bactroban to the nares once weekly for a year.....

anyway those of you that get to do simple surgical procedures and such: what are your follow-up and treatment procedures?

[PICUPNP]

I my region 70-80% peds patients are MRSA+. I am hospital based and usually end up seeing a LARGE # of abscess treated in the clinic with bactrim. Clindamycin is our first line drug for abscess 6mg/kg/TID x 10 days after a 24hr course of IV clinda. I have seen probably 5% of the abscess not sensitive to clinda.

[JDCitizen]

are any of you all running into multiple resistances (3-4+)? i mean i have healthy looking young folks with multiple resistant mrsa it is pretty scary.. i myself don't believe tht i give out antibiotics like candy but if its bad enough that i take out a scalpel and cut i believe it justifies being treated.

[meandragonbrett]

are any of you all running into multiple resistances (3-4+)? i mean i have healthy looking young folks with multiple resistant mrsa it is pretty scary.. i myself don't believe tht i give out antibiotics like candy but if its bad enough that i take out a scalpel and cut i believe it justifies being treated.

jd,

i'm a 25 year old icu rn. not a single health problem in the world. i've picked up a multi-drug resistant strain of mrsa and it's been ridiculously hard to get rid of!

[JDCitizen]

I agree: Can be very hard to get rid of....

I have some patients never needing to return while others its like clock work....

[meandragonbrett]

I agree: Can be very hard to get rid of....

I have some patients never needing to return while others its like clock work....

I would be the one like clock work....about every 3 weeks and it's back. BLAH!

[melmorris]

I see a lot of abcesses - Am in South TX - we see lots of MRSA -- here they are the most sensitive to Bactrim / Doxycycline/ clindamycin-- usually on a bad abcess we will do Bactrim DS bid and Doxy bid x 10 days - occasionally also give Clindamycin injection as boost before these antibx

[JannH]

The ER where I work has low (

Where can local drug-resistance rates in my area be found? Any specific web site?

Thanks in-advance.

[nomadcrna, DNP, CRNA, NP]

Ask your pharmacy for a antibiogram.

[Corey Narry, MSN, RN, NP]

Not to do a shameless plug but if you have a smartphone, epocrates has a new app called Bugs+Drugs (for iPhone and Android users). It basically uploads the antibiogram for your specific location and reveals the antibiotics most effective in treating common bacterial infections (E coli, Staph, Klebseilla, etc. ). As a hospital-based NP, I rely on our institution's antibiogram but I think this can be useful for community-based NP's.

PS - I don't own epocrates stock.

[allennp]

I just did a lit review for our group with presentation about this issue...in the spring. There are a couple of studies out...small, that show for abscesses less than 5 cm that they do just as well with I&D alone, some folks are using the loop technique that you put two incisions in loop a plastic coil thru, have them return in ten days snip it and they are out the door, no antibotics, good forbthe homeless who won't take them right, won't return for packing change, and can cut the loop on there own. Yes, 80% ....numbers vary of abscesses are MRSA, but again it's stab and drain as the mainstay. That being said...I still will often give antibiotics, keflex and bactrim, and await cultures, but now not with all. Maybe.........20% of my abscesses less than 5cm I will send home without depends on the patient. But yes there are conversations that a lot of these do not need antibiotics.

[ChrisRN75495]

I'm a little curious--doesn't anyone use simple solutions any more? No bacteria pathogenic to humans can survive salt. MRSA on skin? Clean well with epsom salts in the shower at least once per day and wash hands frequently. If abscess formation is present, dakins (or in one case I know where it worked--seemed extreme but worked--1:5 or 6 bleach to water dabbed on a couple of times a day). Another remedy which seems to work along with staying clean and cleaning with epsom salts was sprayed on frankincense in water (available for about $11 for four ounces).

You may laugh but I know of several people who knocked their MRSA out and kept it away using the epsom salts and frankincense approach. To be completely honest, the frankincense was in solution with myrrh, both as essential oils, in a ratio of about 1:20. I&D opens patients to spread and if they are not using good hygiene to begin with....? And antibiotics may be helpful but didn't that get us here in the first place?

I do recognize that MRSA can be acquired quite innocently, and that hygiene isn't the only factor in abscess formation.

And of course epsom salts is about $3 for 10 lb and no pharmaceutical company is making anything from it....

Just curious if anyone else has used a more natural approach (not that I think of bleach as natural, but it is less invasive and risky than antibiotics)....

Thanks.

[nursetim, NP]

I used to be known as the "boil moil". If I'm sure it MRSA, bactrim DS, if no allergy to sulfa drugs, then keflex until culture report came back. The problem I see with dakins, salt, or iodine, is they are indiscriminate cell killers. Anybody ever levage the cavity with ancef or rocephin? And packed with same soaked in whatever abx used?