MRSA associated abscesses are a frequent occurrence in the pediatric population. MRSA is a type of staphylococcus infection that takes advantage of any break in the skin, causing a local skin infection and the development of an abscess beneath the skin. This form of a staphylococcal infection is more aggressive than a routine infection, as it has a specialized enzyme that causes tissue destruction and leads to abscess formation in a very short period of time. Families often report the occurrence of a small pimple-like lesion or insect bite-sized lesion of the skin that develops into a multi-inch region of redness, swelling and tenderness over a 24 hour period of time. These lesions often do not “come to a head” but develop extensive underlying tissue destruction. The identification of an aggressive course to the infection with significant extension of the infection through the skin should warrant urgent evaluation by a medical professional for assessment.
Clinical evaluation alone should determine the severity of a skin infection. Those areas of infection <1 inch in size may allow for a trial of oral antibiotics to see if the infection may subside. However if there is a progression of the skin infection while on antibiotics or significant involvement of the skin (>1 inch) prior to antibiotics, a referral to a surgeon should be done semi-urgently.
Again, the extent of tissue infection should be obvious by medical evaluation with little need for additional testing. If there are concerns with regards to possible abscess formation, an ultrasound may be obtained to help better evaluate the lesion. Most areas of infection do not present as a superficial abscess but one that lies deeper in the tissue, often involving the entire area that has associated redness.
Treatment for these noted abscesses and severe infection is surgical. The goal of surgery is to drain the fluid from the underlying abscess. In our practice the treatment of the subcutaneous abscess and its surgery are approached by making counter incisions along the center and periphery of the incision at numerous locations to allow for drainage of the infection. Additionally, small “rubber band” type drains are placed through the skin to keep the skin incisions open, allowing for its continued drainage. In doing this along with washout of the abscess cavity, a significant response is seen over the first 24 hours while maintaining treatment with intravenous antibiotics. Intravenous antibiotics are maintained until near complete resolution of the skin redness. Antibiotics are then continued for up to one week utilizing oral antibiotics of either Clindamycin or a sulfa-based antibiotic (e.g. Septra TM)along with local wound care. The wound is cleansed twice a day with soap and water and follow-up is performed in one week for inspection of the wound and removal of the skin drains. Following this, simple wound cleansing is all that is needed to offer complete healing of the wound.
Your surgeon may also consult infectious disease specialists to help give the best recommendations for treatment of both the child, as well as the family, to minimize such recurrences within the family or other family members contracting the skin infection.