line. Tony found it humorous that his “gooey zits” got quick attention at an ED known for its long wait times. Dr. Bergmann, an infectious disease physician, examined Tony, noting heat, extreme erythema, folliculitis, 15 boils ~1–2 cm in diameter, some draining copious amounts of pus, and numerous seeping ulcerations. Dr. Bergmann applied a topical anesthetic before lancing several boils for culture. He ordered four sets of blood cultures drawn, started broad spectrum IV antibiotics, and immediately scheduled Tony for surgical debridement of his infection.
Why did the doctor lance boil to collect a specimen for culture when many others were already draining pus?
Why did Dr. Bergmann start Tony on antibiotics even though he didn’t know the microbe involved or its drug sensitivity?
Why were blood cultures ordered?
Why was Tony a candidate for immediate surgery?
Tom and Julia sat for about an hour in the waiting room before Dr. Bergmann arrived with an update on Tony’s condition. Preliminary Gram stain results from the lab conﬁrmed Gram-positive clusters of cocci in Tony’s boils. Due to the extensive tissue damage, Dr. Bergmann conﬁded to the family that he suspected community acquired-MRSA. Although Tony was “resting uncomfortably,” the surgical debridement of a 3.5 cm 10 cm area was a success. Tony would receive a three-week course of IV vancomycin before being permitted to return to work.
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What common skin microbes demonstrate this Gram morphology and staining?
What does MRSA stand for?
What is the difference between community acquired-MRSA and hospital acquired-MRSA?
How does the resistance demonstrated by this organism differ from the resistance it typically shows to penicillin?
Why is vancomycin a good treatment choice when penicillin and methicillin are ineffective?
What complications are associated with IV vancomycin treatment?
Tony’s infection progressed rapidly and resulted in substantial soft tissue damage. Why is MRSA able to cause this problem?