Tag Archives: Methicillin-resistant Staphylococcus aureus

Straight, No Chaser: Abscesses (Boils)

September 29, 2016Infectious Disease, Skin/Dermatology844-SMA-TALK, Abscess, Behind the Curtain, Cellulitis, Folliculitis, Incision and drainage, Methicillin-resistant Staphylococcus aureus, Staph, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, streptococcusJeffrey Sterling, MD

Whether you call them boils, pus pockets or abscesses, they hurt. Abscesses are infections that localize and collect pus beneath the skin. Although previous Straight, No Chaser posts have addressed MRSA, this one will highlight your frequently asked questions about abscesses.

Why do I get an abscess?
Something causes an injury or sufficient irritation to your skin to allow bacteria to enter, and/or your lowered immunity can’t adequately fight back. Examples of circumstances causing skin infections that can develop into abscesses include ingrown hairs (folliculitis), insect bites and IV drug use. You are at increased risk for developing an abscess if you have diabetes, are obese, use IV drugs, have a weakened immune system or have an untreated skin infection (cellulitis).

What causes abscesses?
Bacteria such as Staphylococcus aureus (Staph) and Streptococcus are common causes of abscesses. I’ll remind you that MRSA stands for methicillin-resistant Staph Aureus; this is an indication that traditionally used antibiotics don’t work against this particular strain of bacteria. MRSA should be a reminder of the dangers of inappropriate antibiotic use.

How do I know if I have an abscess?
Trust me. You’ll know. Typically you’ll develop a skin infection first, which could simply include pus-filled bumps that worsen to become red, warm, swollen and tender. You may develop a fever, and you will have a significant amount of pain.
Can I treat these at home?
Generally not unless you’re a physician or have access to one at home… What you can do is prevent them. Stop picking at your skin; in fact, learn to keep your hands off your skin. Use clean equipment (e.g. razors, clippers) if you shave hair from your skin.
In terms of treating abscesses at home, it is not advisable for you to attempt to cut yourself or otherwise deal with these once one has formed. Abscesses often have deep tracks under the skin that need to be explored. Whatever you’re doing to delay getting evaluated is increasing the risk that things will worsen.

So how are abscesses treated?
There are two approaches to treating abscesses: “from the inside out” and “from the outside in.”

From the inside out refers to receiving antibiotics. Most abscess do respond promptly to antibiotics if you don’t wait too long to get them treated.
From the outside in refers to a procedure called incision and drainage (I & D). You’ll recognize this as your physician having to cut open the abscess, clean the area out and place gauze in the wound for a few days. Doing this in most cases eliminates the need to also take antibiotics. Unfortunately, I & Ds often must be done on higher risk abscesses, and in some instances, it’s necessary to have it done by a surgeon.

When should I see a doctor for one of these?
These generally aren’t getting better on their own. In particular, if you have one of the risk factors previously mentioned (diabetes, IV drug use, obesity, decreased immunity), the abscess is on or near your genitalia, is spreading fast or is extremely painful, you should be seen sooner rather than later.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: MRSA, the Big, Bad Staph Infection

September 28, 2016Infectious Disease, Skin/DermatologyStraight No Chaser, 844-SMA-TALK, Antibiotic resistance, Behind the Curtain, Infection, Methicillin-resistant Staphylococcus aureus, MRSA, Spider bite, Staphylococcus, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.comJeffrey Sterling, MD

One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.

Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Abscesses (Boils)

July 22, 2014Infectious Disease, Skin/DermatologyStraight No Chaser, streptococcus, SterlingMedicalAdvice.com, 844-SMA-TALK, Abscess, Cellulitis, Folliculitis, Incision and drainage, Methicillin-resistant Staphylococcus aureus, Staph, Staphylococcus aureus, Sterling Medical AdviceJeffrey Sterling, MD

So how are abscesses treated?
There are two approaches to treating abscesses: “from the inside out” and “from the outside in.”

From the inside out refers to receiving antibiotics. Most abscess do respond promptly to antibiotics if you don’t wait too long to get them treated.
From the outside in refers to a procedure called incision and drainage (I & D). You’ll recognize this as your physician having to cut open the abscess, clean the area out and place gauze in the wound for a few days. Doing this in most cases eliminates the need to also take antibiotics. Unfortunately, I & Ds often must be done on higher risk abscesses, and in some instances, it’s necessary to have it done by a surgeon.

Straight No Chaser: About that 'Strep Throat'

September 14, 2013General Health and Wellness, Head/Eyes/Ears/Nose/Throat, Pediatrics/Kids HealthSore throat, Antibacterial, Evidence-based medicine, health, Methicillin-resistant Staphylococcus aureus, Streptococcal pharyngitis, Throat, Throat cultureJeffrey Sterling, MD

Here’s a pretty common scenario. You’re a first time parent with the most adorable kid in the world. You’re in full tiger mom or dad mode, and you’re not going to let anything in the world hurt your baby. Your child has a sore throat, and you’re worried that it could be strep throat. You want to know if s/he needs antibiotics (Actually, you’re demanding antibiotics, but that’s another conversation!).
If a physician is actually using evidence based medicine to treat you instead of just throwing antibiotics at you to make you feel better (We call that ‘treating the parents’), there are criteria (based on what is called a Centor score) that determines when antibiotics are indicated and will make a difference (because most sore throats are caused by viruses and don’t respond to antibiotics; they’ll get better on their own in time). The Centor score is simple enough that you could figure it out yourself. Here are the components.
The patients are judged on six criteria, with one point added for each positive component.

History of fever
Tonsillar exudates (those white patches in the back of the throat)
Tender anterior cervical lymph nodes (those swollen lumps in the upper neck right below the angle of the jaw)
No coughing
Age <15 add 1 point (because strep is more likely at this age)
Age >44 subtract 1 point (because strep is way less likely at this age)

After that, you’ll have a number. Physicians use that number to guide management as follows:

0 or 1 points – No antibiotic or throat culture is necessary; the risk of strep. infection is less than 10%.
2 or 3 points – A throat culture should be done, and the patient should be treated with an antibiotic if the culture is positive.
4 or 5 points – The patient should be treated with an antibiotic (The risk of strep. infection is 56%), and no throat culture needs to be done.

So… if you do this calculation at home and get a 0 or 1, don’t expect antibiotics, and don’t get mad when you don’t get them. There are consequences to inappropriate usage of antibiotics. As I’ve discussed in the past (as with Staph becoming MRSA, for example), antibiotic resistance is a real phenomenon with dangerous ramifications for patients. At a patient, you really don’t want to take medications unnecessarily. Microorganisms develop resistance when you’re taking medications inappropriately. You want to remain such that when you need them, they work.
I’m happy to answer any questions or take any comments. Thank you.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: MRSA, the Big, Bad Staph Infection

September 8, 2013Skin/Dermatology, Infectious DiseaseAntibiotic resistance, Infection, Methicillin-resistant Staphylococcus aureus, MRSA, Spider bite, Staphylococcus, Staphylococcus aureusJeffrey Sterling, MD

One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress