Brief synopsis: Emergency rooms are early-warning sites for detection of community-associated MRSA. Alert personnel there see the bug in all its manifestations, from minor skin infection to major invasive disease. They have been among the earliest voices warning everyday physicians of the need to change prescribing habits. They also, as the article discusses, may be at risk from the bug.
The story starts with an anecdote from one of my many post-Katrina reporting trips to New Orleans (stay tuned for a big story coming on that next month!):
The patient, a man in his 20s, walked into the emergency department (ED) on an autumn afternoon complaining of pain from a fist-sized lump under the right corner of his jaw.
The residents who had rounded on him recited their findings. He was not febrile. He was having no dental pain. The lump was thick-walled and unyielding and its outer temperature matched the nearby skin. Peter Deblieux, MD, director of emergency services at Louisiana State University Interim Hospital, asked for a syringe to aspirate it. ...
Deblieux masked the syringe with his free hand—the patient had confessed he was terrified of needles—slid the needle in, and smoothly pulled back. The cylinder filled with a creamy, cloudy substance streaked with red.
“It’s pus,” Deblieux said disbelievingly. “I was not expecting that.”
Ten years since it was first recognized as a significant pathogen, community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA, still retains the element of surprise.
Full text is here.
The New England Journal of Medicine has put the full text one of the most important papers about MRSA in ERs (Moran GJ, Krishnadasan A, Gorwitz RJ, et al.. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–674) online for free.
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