INFECTIONS - Medicine for Mountaineering and Other Wilderness Activities - page 306

Antibiotics are unnecessary forasmall, uncomplicated abscess. However,ifthe abscess
is surrounded by red skin that is more than 0.8 inch (2 cm) in width, or if fever, chills,
or other symptoms are present, oral clindamycin (Dalacin® and others) and TMP-SMX
should be given until all evidence of infection has been absent for two days.
Methicillin-Resistant Staphylococcus Aureus (MRSA)
Methicillin-resistant Staphylococcus aureus (MRSA) was first described in 1961 and is
currentlyfoundworldwide.Itisspreadbydirectcontact, bysharingpersonalitemssuchas
towels or razors that have touched infected skin, and by touching surfaces or items such as
used bandages contaminated with MRSA.
These organisms produce abscesses just like other staphylococci. Because MRSA are
resistant to all penicillins and cephalosporins, alternative agents, such as TMP-SMX and
clindamycin should be used. Similar therapy should be instituted, even without signs of
bloodstream or secondary infection, if the individual has multiple abscesses or is diabetic,
since diabetes may predispose to severe infections.
Individuals who do not respond promptly to incision and drainage and appropriate an-
tibiotics should be evacuated to a medical center where infectious disease specialists and
intravenous medications are available.
Cellulitis
Cellulitis is a bacterial infection of the skin and underlying tissues produced by organ-
isms that do not cause obstruction of blood vessels. Such infections do not tend to remain
localized, and the bacteria can spread to other areas more easily than can some other bac-
terial infections. The site of the infection is usually red, swollen, hot, and tender. Fever is
usually present.
Sincethebloodvesselsremainopen,theseinfectionscanbesuccessfullytreatedwithout
drainage. A cephalosporin and TMP-SMX should be administered until all signs of in-
fection have been absent for two days. Clindamycin can be substituted for either of these
agents if the individual is allergic to that drug. The person should rest quietly until the in-
fection has cleared. Due to its propensity to spread, cellulitis can be a more dangerous in-
fection than an abscess, and its potential for complications must be respected.
Bacteremia
Bacteremia is defined as the presence of bacteria in the bloodstream. The organisms
may multiply in the blood and produce infections throughout the body. Bacteremia is usu-
ally preceded by a localized infection such as an infected wound, a urinary tract infection,
or an abscess but may also accompany intestinal infections, such as typhoid fever.
Bacterial bloodstream invasion produces chills, high fever, sweating, and prostration.
Specific signs may indicate spread of the infection to other parts of the body. Severe head-