Methicillin-resistant Staphylococcus aureus furunculitis in the outpatient burn setting

Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more predominant in the community. We have seen increasing cases of furunculitis in our outpatient burn clinic, which appear to develop weeks after the initial burn injury and in patients with limited inpatient stays. We performed a 3-year retrospective review of all outpatient burn patients who developed furunculitis. Data analyzed included length of hospital stay, type of injury sustained, culture and sensitivity results, and treatment provided. A total of 28 patients were identified with MRSA furunculitis, which presented as painful, hard, indurated boils with minimal purulent drainage. Adults had less extensive burn injuries (mean of 12% TBSA adults vs 20% TBSA children) with shorter hospital stays (mean 8 days adults vs 22 days children). Fifty-seven percent of the patients had multiple furuncules, involving both burned and nonburned areas. Patients with furunculitis had a less resistant MRSA strain than those without furunculitis. Of the 22 patients who received systemic antibiotic coverage, 14 (58%) were successfully treated with 1 antibiotic regimen, whereas 8 (33%) required multiple antibiotics. In this study, furunculitis in the outpatient setting was believed to be consistent with community-acquired MRSA. Incision and drainage was not sufficient in patients with multiple furuncles, and systemic antibiotics were administered. Through increased awareness of the prevalence of community-acquired MRSA in the community, appropriate antibiotic treatment can be initiated, and the discomfort and transmission risk associated with this disease can be minimized.