Incision and drainage best option for small abscesses associated with CA-MRSA

There are conflicting data regarding the best approach for treating children who are colonized with community-associated methicillin-resistant Staphylococcus aureus, but incision and drainage may be enough for abscesses less than 5 cm, according a speaker at the National Foundation for Infectious Diseases’ 2010 Annual Conference on Antimicrobial Resistance in Bethesda, Md.

Sheldon L. Kaplan, MD, an Infectious Diseases in Children editorial board member, cited data that indicated that 90% of children colonized with CA-MRSA in one study population showed improvement during follow-up with incision and drainage alone.

However, Kaplan said physicians should still consider antimicrobial and antibiotic therapy when treating young children, children with underlying conditions or complications associated with the disease.

He said vancomycin remains the gold standard of antibiotic treatment for CA-MRSA, adding that clindamycin — when more than 90% of isolates are clindamycin-susceptible — and linezolid are also recommended under certain circumstances.

Invasive infections associated with CA-MRSA such as osteomyelitis are also on the rise, according to Kaplan.

He cited results from a study at Le Bonheur Children’s Medical Center in Memphis, Tenn., that showed an increase in the number of isolates of MRSA associated with bone and joint infection. That data also indicated a correlation between the presence of Panton-Valentine leukocidin and severity of infection, but Panton-Valentine leukocidin’s role in disease severity is still under debate, Kaplan said, noting that data exist that support magnetic resonance imaging over bone scans in detecting osteomyelitis.

He said the USA300 pulsotype, the most commonly associated with CA-MRSA, contributes to the development of thrombosis associated with osteomyelitis and septic arthritis in patients with CA-MRSA. Kaplan cited recently published data from Carillo-Marquez et al that revealed a relationship between these conditions and USA300. – by Melissa Foster

For more information:

Kaplan S. Diagnosis, treatment and prevention of methicillin-resistant S. aureus (MRSA) infections in children. Presented at: 2010 Antimicrobial Conference on Antimicrobial Resistance; Feb. 1-3, 2010; Bethesda, Md.

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