All you guys will of course be interested in hearing about this -- so be on the lookout, and keep your Johnson under wraps --
Vulvar Abscesses Commonly Caused by MRSA
By Will Boggs, MD
NEW YORK (Reuters Health) Sept 18 - The organism most frequently isolated
from vulvar abscesses is methicillin-resistant Staphylococcus aureus (MRSA),
according to a report in the September issue of Obstetrics & Gynecology.
"We want ob-gyns to realize that vulvar abscesses, like other skin and soft
tissue infections, have a high incidence of MRSA," Dr. Andrea Ries Thurman
from the University of Texas Health Sciences Center, San Antonio, told
Reuters Health. "You cannot predict MRSA (versus other bacteria) by looking
at the patient."
Dr. Thurman and colleagues sought to determine the incidence of MRSA in a
large cohort of women with vulvar abscesses who were treated with either
inpatient or outpatient surgical incision and drainage, and to identify
clinical factors associated with MRSA vulvar abscesses.
MRSA was isolated from 64% of vulvar abscesses, the investigators report,
and other non-MRSA organisms (mainly labeled "usual genital flora") were
isolated from 36% of vulvar abscesses.
Most MRSA isolates were sensitive to clindamycin (72%),
trimethoprim-sulfamethoxazole (96%), or doxycycline (96%).
No presenting signs, symptoms, or epidemiologic variables significantly
predicted MRSA vulvar abscesses, the report indicates, and MRSA infection
was not associated with inpatient treatment or the occurrence of any
short-term complication.
In a multivariable logistic regression analysis, inpatient admission was
independently associated with larger abscesses (5 cm or more) and with an
initial blood glucose of 200 mg/dL or more.
"Our study demonstrates that vulvar abscesses are a morbid condition, with
40% of women requiring inpatient treatment for an average of 3 days," the
investigators say.
"Our data suggest that if an oral antibiotic is prescribed,
trimethoprim-sulfamethoxazole should be the first line of treatment, because
this medication covered almost all of the MRSA and non-MRSA species
recovered from vulvar abscesses," the authors conclude.
"We plan to look at placebo versus Bactrim after incision and drainage of
vulvar abscesses," Dr. Thurman commented.
Obstet Gynecol 2008;112:538-544.
medscape.com |
