From the Guidelines
To screen for MRSA in recurrent axilla skin infections, collect a culture sample from an active lesion using a sterile swab and send the specimen for bacterial culture and sensitivity testing, specifying "MRSA screening" on the laboratory requisition. When dealing with recurrent skin and soft tissue infections (SSTIs), such as those in the axilla, it's crucial to consider the possibility of MRSA infection, especially if the infections recur despite proper wound care and hygiene measures 1. The approach to screening and management should prioritize identifying the causative organism to guide appropriate antibiotic therapy and consider decolonization strategies if necessary.
Key considerations in managing recurrent axilla skin infections include:
- Collecting a culture sample from an active lesion for bacterial culture and sensitivity testing to identify MRSA
- Specifying "MRSA screening" on the laboratory requisition to ensure appropriate testing
- Considering empiric treatment with antibiotics that cover MRSA, such as trimethoprim-sulfamethoxazole, doxycycline, or clindamycin, while awaiting culture results
- Implementing decolonization strategies for patients with recurrent infections, which may include nasal decolonization with mupirocin and topical body decolonization regimens with a skin antiseptic solution like chlorhexidine, as recommended by guidelines 1
It's essential to note that decolonization strategies should be considered in selected cases, such as when a patient develops recurrent SSTIs despite optimizing wound care and hygiene measures, or when ongoing transmission is occurring among household members or other close contacts 1. The use of nasal decolonization with mupirocin twice daily for 5–10 days, and topical body decolonization regimens with a skin antiseptic solution for 5–14 days, can be effective in reducing the risk of recurrent infections 1.
In the context of real-life clinical medicine, making a firm decision on the side of caution is crucial, especially when dealing with potentially resistant organisms like MRSA. Therefore, screening for MRSA and considering decolonization therapy are critical steps in managing recurrent axilla skin infections, as they can significantly impact morbidity, mortality, and quality of life by reducing the risk of recurrent infections and transmission to others.
From the Research
Screening for MRSA in Recurrent Axilla Skin Infections
To screen for MRSA in cases of recurrent axilla skin infections, it is essential to consider the following steps:
- Identify the causative organism of the skin infection through culture and sensitivity testing 2
- Use antibiotics that are effective against MRSA, such as doxycycline or trimethoprim-sulfamethoxazole, as initial therapy for skin and soft tissue infections when MRSA is suspected 2
- Consider decolonization strategies for patients with recurrent skin infections, including household-based approaches 3
- Be aware of the local epidemiology of MRSA and adjust treatment accordingly 4
Diagnosis and Treatment
Diagnosis of MRSA skin infections can be challenging, but the use of bioluminescence imaging has shown promise in evaluating the efficacy of systemic and topical antibiotics against CA-MRSA-infected skin wounds in mice 5
- Incision and drainage (I&D) remains the standard of care for skin abscesses, but the use of post-procedural antibiotics and wound packing is still a topic of debate 6
- Current guidelines recommend using new antimicrobials and shorter antibiotic treatment courses, with a focus on stewardship programs and collaborative management 4
Prevention of Recurrent Infections
Prevention of recurrent skin infections is crucial, and strategies such as decolonization and household-based approaches have shown promise 3
- Asymptomatic carriers can serve as reservoirs for transmission, highlighting the importance of a household approach to decolonization 3
- Novel strategies for the prevention of recurrent skin infections are needed, including the development of new antimicrobials and more effective decolonization methods 3