It's officially an epidemic. As the junior surgeon at the hospitals where I staff, I tend to get more than my share of perianal abscesses, "butt pus", and other consults for various subcutaneous abscesses needing incisional debridement. It used to be, you'd drain them in the ED, tell them remove the packing in 24 hours and start three times a day sitz baths subsequent to that. We'd see them in 7 or 10 days and all evidence of sepsis had resolved. Not any more. I had a lady about 6 months ago, a PR vice president, who came to see me about a buttuck abscess. I drained it. The induration and erythema persisted. She got another one on the other butt cheek, and the beginnings of one on her medial thigh. I took her to the OR, opened everything up and placed a penrose drain. Final cultures: Methicillin Resistant Stapholococcus Aureas (MRSA). She ended up going home with six weeks of doxycycline. This was an upper middle class lady who was absolutely traumatized. MRSA used to be the bane of ICU's, the so called nosocomially acquired infections. Now, it's become a widespread community acquired infection. Why is this a problem? It's an aggressive little sucker, for one. You can't eradicate it simply by doing an I&D (incision and drainage). It comes back. Always. And not necessarily in the same place. Antibiotics must complement the I&D. And penicillin derivatives don't work. Or Levofloxacin. Or Clindamycin or anything else except for IV Vancomycin, doxycycline, Linezolid (if you feel like dipping into your IRA), and occasionally Bactrim.
I changed my practice after that lady. I culture all abscesses now. If the preliminary reading from the lab demonstrates gram positive cocci in clusters, I call in a prescription for Doxycycline. Patients that look septic get admitted for IV vanco. Often, I refer them to an Infectious Disease specialist. Sometimes I can even tell if it's going to be MRSA or not clinically. MRSA infections tend not to have the foul smelling, purulent pus that you see with a typical E Coli perianal abscess. There's a lot of induration and erythema, but a strange absence of white pus. It's almost a brownish, necrotic purulence. Those people I start on Doxycycline right away.
The last 15 subcutaneous abscesses I've had to drain, 14 of the cultures came back MRSA. (I've kept track). And all patients were young, relatively healthy people who were admitted from the community. Not one was a chronic ICU lingerer. So the next time you notice a boil or persistently reddened, painful mosquito bite, don't blow it off. Go see your FP.