Skin and Soft Tissue Infection
There is a tremendous amount of cellulitis and abscesses in the YK Delta. We have a lot of community acquired MRSA infections here, probably from the lack of running water in many of our villages. I and D is our first line treatment for all boils. Many of the health aides can I and D simple abscesses – but small children and complicated ones we have sent to Bethel – to be seen in clinics or ER. Please culture all abscesses when you do an I&D so we can get a sensitivity on the organism!!!!!! That is the only way we know what we are treating. We have two great cellulitis and abscess guidelines (one for outpatient evaluation and treatment and one for severe) – please refer to them. If the erythema is over 10x10 cm, antibiotics are recommended after I&D. Most of the MRSA is sensitive to Septra with Doxycycline as second line for po treatment. We prefer the use of penrose drains if at all possible in our patients, especially in children.
If the cellulitis is huge – they may be started on IV meds. As the resistance to fluorquinolones is increasing – we have been using mostly IV Vancomycin. If the patients are stable we may have adult patients come back Q12 hours to get their antibiotics on an outpatient basis (pediatric patients must be admitted for IV treatment). If the cellulitis doesn’t seem to be resolving, they will be admitted. Lower extremity cellulitis should have a low threshold for admission.
- Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus, Rural Southwestern Alaska -- Michael Z. David, et al
- Methicillin-Resistant Staphylococcus aureus - Associated Hospitalizations among the American Indian and Alaska Native Population -- Kathy K. Byrd, et al
- Community-Onset Methicillin-Resistant Staphylococcus aureus Associated with Antibiotic Use and the Cytotoxin Panton-Valentine Leukocidin during a Furunculosis Outbreak in Rural Alaska -- Henry C. Baggett, et al
- IDSA 2014 Guidelines for Skin and Soft Tissue Infections
- Hayes BD, O’Brien M. One-time Vancomycin Doses in the Emergency Department. ALiEM. https://www.aliem.com/one-time-vancomycin-doses-ed/. Updated May 1, 2021. Accessed June 7, 2021.
- Stevens DL, Bisno AL, et al. Practice guidleines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. CID. 2014;59(2):e10-52.
- Abscess Incision and Drainage (I&D) (YKHC Wiki Common ED Procedure Guide)
- Skin and Soft Tissue Infection YKHC Clinical Guideline