Methicillin-Resistant Staphylococcus aureus
Skin and soft tissue infections (SSTIs) and abscesses at the vulva, vagina, groin, breast, and postoperative wounds are vulvar manifestations of methicillin-resistant Staphylococcus aureus (MRSA) infections. Nearly two-thirds of cultures revealed MRSA. Tr
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Sara Wood
46.1 Introduction Methicillin-resistant Staphylococcus aureus (MRSA) infections relevant to the women’s health care provider include skin and soft tissue infections (SSTIs) and abscesses at the vulva, vagina, groin, breast, and postoperative wounds. MRSA infections commonly exhibit purulence and abscess formation due to virulence factors which inhibit phagocytosis and destroy neutrophils [1–3]. The genital region is particularly predisposed to MRSA colonization and infection due to practices of hair removal via shaving/waxing, sexual relations with other MRSA carriers, sharing of personal hygiene products, or poor hygiene practices due to obesity or immobility [3]. In two of the largest cohort studies of women with vulvar abscess, nearly two-thirds of cultures revealed MRSA [2, 3]. Thus, culture should be obtained in cases of a vulvar abscess, and empiric treatment with coverage for MRSA is recommended. Further directed antibiotic therapy is based on the results of culture sensitivities. Incision and drainage (I&D) with disruption of any loculation followed by dressing with clean, dry bandages is important in the treatment of
S. Wood (*) Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mercy Hospital St. Louis, St. Louis, MO, USA
abscesses, furuncles, and carbuncles within the vulva [4, 5]. Studies have revealed that trimethoprim- sulfamethoxazole (TMP-SMX) is largely effective against MRSA along with other common vulvar abscess microbes, such as Proteus, Escherichia coli, and group B streptococcus [2, 3, 5]. Other antibiotic options include tetracyclines (i.e., doxycycline or minocycline), clindamycin, or linezolid [4–6]. However, local antibiotic resistance patterns should be taken into account during antibiotic selection as studies have reported significant resistance to clindamycin in up to 65% of isolates [2, 6]. Treatment courses are dependent on the resolution of symptoms [4, 5]. A careful history may reveal comorbidities that may indicate whether inpatient hospitalization is necessary. An outpatient course of oral antibiotic treatment in addition to I&D in the presence of an abscess with serial examination is appropriate in patients with risk factors, such as diabetes mellitus, obesity, immunosuppression, pregnancy, trauma, or iatrogenic trauma [5]. Hospitalization has been proposed for patients with an abscess of greater than 5 cm or blood glucose levels greater than 200 with appropriate surgical and antibiotic interventions as displayed in Table 46.1 [3, 7]. Recurrence of MRSA abscess or SSTI should prompt investigation into predisposing conditions, such as improper wound care, poor personal hygiene, sharing or reusing of personal
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_46
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S. Wood
302 Table 46.1 Intravenous antibiotics for purulent vulvar infections Moderate infectiona Severe infectionb
MRSA: TMP/SMX MSSA: Dicloxacil
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