Sounds like you have seen a ton of this, which is to be expected I guess in the isolated population at a prison.
Our ID guys are still recommending Septra. In fact we aren’t even allowed to prescribe clindamycin in our hospital because of the high rate of c. diff colitis. We haven’t tried minocycline yet that I’m aware of. I’ll ask one of the ID guys next time I see one and I’ll check our cultures in the future to see if our local strains are susceptible.
Yeah, MRSA is a real headache for our prison system. We restrict the inmates from transferring to other prisons in our system until they stop draining. We even postpone court appearances as we don’t want them to sit in a county jail, where frankly they might not get their meds reliably.
We see tons of MRSA coming in from the county jails. So we’re playing a lot of catch-up on guys who had no treatment at all in jail, or had the shotgun approach used to the infection: No cultures done but a fistful of antibiotics prescribed.
IME, minocycline works pretty damn good. And I’ve seen a couple of cases of C. Diff on clinda, but one guy had Crohn’s anyway. We use a fair amount of clindamycin. Patient education and good follow-up is key. (Surprise, right?)
We saw an awful lot of CA-MRSA at my residency hospital (in a different part of NC). It seemed to hit us all at once a couple of years ago. It was especially strong in our (very large) HIV population, but I’m seeing a heck of a lot of it around here now, where HIV is (relatively) practically nonexistent.
We used doxycycline in residency, and that’s what I use now.
While CA-MRSA is definitely a problem, I think there’s a danger of overreacting to it. I’ve seen a few docs who get the results showing MRSA in a minor abscess and immediately jump to big-gun antibiotics like linezolid or admit the patient for vanc and clinda, just because that’s what you do for MRSA. Worse still are the well-meaning patients who do a web search for MRSA and wonder what kind of quack just sent them out with pills and a follow-up appointment.
It’s useful to think of CA-MRSA as a separate entity from the multi-resistant hospital-acquired version; it’s like the tough-looking but slow cousin who learned how to duck the penicillins but not much else. This seems to be improving, but the danger still exists.
(Note: after thinking about it, this may not apply so much elsewhere. Both here and in residency, all but a handful of the MRSA cultures we got back fell into one of two strains–one that was resistant to everything but vancomycin, and one that was resistant to the penicillins but pretty sensitive to just about everything else. The CA-MRSA we saw was almost exclusively the latter type. Other places may have more in-between strands.)
My sister did the IV thing when she had it a few years back. It was a stubborn case that required her to go to the hospital a couple times.
I also have a friend who got a bone infection (can this be acquired from cellulitis?) and he did IV treatments three times a day every day for six weeks. It was awful.
Holy crap, I guess sometimes it actually is a spider.
Christ. I will be sleeping with one eye open for the rest of my life. This is one of my worst fears. Hence, very little in the way of fresh fruit at Kasa Kalhoun.
Just don’t buy your fruit in crates, and you’re pretty safe.
This seems like an appropriate place to ask: we pronounce it MRSA (saying the letters out loud), but in an episode of House MD they said it phonetically as mersa. Do you guys say it like that or did the TV show get it wrong?
I say “mersa”. Our local ID folks at the university seem to all say “Em Are Ess Ay”.
I made great strides in comprehending this thread once my tired brain grasped that “cellulitis” was not, after all, another word for “cellulite” ??? :smack:
Severe spider or insect bites may be uncommon and/or common mis-diagnoses. But I know the worst pain I ever experienced was from touching a caterpillar. It simply brushed against my hand when it fell from a tree (in Trinidad & Tobago) and the sting was unbearable for number of hours. Ice, ibuprofen, rum didn’t touch the pain, which later spread into my joints (elbow and shoulder). From pictures on the internet I identified it as a Puss Caterpillar, although it was three times larger than the ones that I saw described (that are found in Florida and other southeastern states in the US). It looked like a beautiful little golden guinea pig, but it apparently has poison/toxin/venom/BADNESS in the fibers of its fur that is released upon the slightest touch. There are very bad ants, centipedes and some ugly spiders in the tropics, too.
That’s what you get for moving to Trinidad. Didn’t I tell you before you went? If it’s island paradise you’re after, go to Greenland. Nothing venomous in Greenland.