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Clinical Crossroads Update
January 6, 2010

Update: A 39-Year-Old Man With a Skin Infection

JAMA. 2010;303(1):64. doi:10.1001/jama.2009.1960

In a Clinical Crossroads article published in January 2008,1 Robert C. Moellering, MD, discussed Mr M, a 39-year-old man with episodes of skin infections on his thigh and his left index finger. In the article, Dr Moellering discussed the nature of Mr M's index finger infection, the options for treatment, and the likelihood of recurrence. Mr M had no history of trauma or exposure to a pathogen, had fairly severe pain, was afebrile, and had significant lymphangitic streaking. Based on these symptoms, Dr Moellering identified a streptococcus or a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain as likely culprits and recommended treating with antibiotics to cover both S aureus and Streptococcus pyogenes. He suggested that following Mr M's drainage and intravenous antibiotics, he be discharged taking oral antimicrobial therapy to complete the course. Because Mr M had only had 1 serious infection, Dr Moellering was not concerned that Mr M had an underlying immunodeficiency and, thus, did not recommend workup; Dr Moellering also did not recommend any ongoing prevention or prophylaxis to prevent future infections because of the lack of evidence that such treatment would be efficacious.

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