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DR. CORDOVER: The last question
is, in summary what can we as emergency department physicians
do to respond to this emergent threat?
DR. FOX: My best
advice in response to this question would be:
- First, be aware and cognizant of the community-associated
MRSA as a threat.
- Secondly, stay educated and keep abreast of
developments with community-associated MRSA.
- Third, remember that incision-and-drainage
with or without antibiotic therapy is the mainstay of treatment
in most emergency department settings.
- Fourth, it’s important for the patients
to have a follow-up visit and to probably have some
educational materials sent home with them.
- Fifth, while everyone who works as emergency
department physicians is concerned about this emerging threat,
don’t take it to any type of extreme or state of paranoia.
- Sixth, use your training and clinical judgment
to decide which patients can be discharged from the emergency
department and which patients need to be admitted.
- And finally, of those patients that need to
be admitted, make sure that the diagnosis, bloodcultures
and treatment are begun in a timely fashion in order to reduce
any potential mortality associated with the unusual and infrequent
cases of sepsis.
What ED Staff Can Do
To Respond to the Emergent Threat of CA-MRSA
- Be aware and cognizant of CA-MRSA as a threat.
- Stay educated and keep abreast of developments
of CA-MRSA.
- Remember that incision-and-drainage with or
without antibiotic therapy is
the mainstay of treatment.
- Schedule a follow-up visit for patients and
give them education materials.
- Do not take your concern to extremes.
- Use your training and clinical judgment to
decide which patients should be
discharged or admitted.
- For patients who must be admitted, make sure
that diagnosis, blood cultures and
treatment are initiated in a timely fashion to reduce the
potential for mortality.
DR. CORDOVER: Dr. Fox,
thank you for this excellent information.
MRSA is not something that is going to
go away. An article in the October 17, 2007 issue of the
Journal of the American Medical Association entitled “Invasive
Methicillin-resistant Staphylococcus aureus Infections
in the United States” documents the increasing incidence
and burden of invasive MRSA infections. We emergency physicians
and all our staff members must be prepared to keep abreast
of this escalating threat and the most up-to-date treatment
and management guidelines.
The Appendixes, References and Resources
include links to several management guidelines for MRSA,
including the “CDC Strategies for Clinical Management
of MRSA in the Community” and the “CAMRSA Guidelines
for Clinical Management and Control of Transmission”
which Dr. Fox co-authored.
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