SSTI: Is it CA-MRSA?

[SusanTiso]

In patients who present with minor trauma and early signs and symptoms that are suspicious for infection, determining the risk for CA-MRSA is important for treatment decisions. I had a 51-year-old female patient who is a triathlete and sustained minor abrasions to both shins in a fall about 2 weeks prior to the office visit. She presented with increasing redness, pruritis, and a few tiny blisters at the wounds (superficial) on bilateral anterior lower extremities. She had purchased the "most potent" OTC topical antibiotic she could find after consulting her pharmacist - super strength Neosporin. The wounds were about 2x2 cm abrasions, with a 1 cm halo of erythema. The right side had a small amount of serous drainage. She was concerned because she wanted to do a 100-mile bike ride in the upcoming week!

She did not have any risk factors for MRSA. I cultured the wounds and treated her with Keflex and home wound care instructions. Three days later, she had not improved, C/S was pending (so far negative for MRSA but not final) and she was very worried. I resisted switching her to Bactrim or another antibiotic, and had her discontinue the Neosporin. The redness, itch and blisters resolved within 1-2 days.

Have any of you had similar problems with Neosporin contact allergies? I really think that was the cause if the problem but it’s a tough call with the prevalence of CA-MRSA on the rise.