A Case of Sensitive Staphylococcus Aureus Infection Essay

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Janice was seen in the Infectious Diseases Clinic on December 4, 2013. As you recall, she was being treated for a very complicated methicillin-sensitive Staphylococcus aureus infection which was multifocal in nature. She had several skin lesions including a carbuncle on the right lower leg, a septic right knee and a large subpectoral and subdeltoid collection on the left. Despite a history of penicillin allergy she was given a staged challenge with cloxacillin and tolerated this well. She has been on antimicrobial therapy since her initial presentation to hospital in early October. This constitutes approximately 9 weeks of IV antibiotic treatment as of today's visit. I have received several reports from the CCAC that Janice has not …show more content…

The skin appears well healed. The heart sounds are normal with no murmurs or extra heart sounds. Her lung fields are clear to auscultation and percussion. The previous carbuncle is completely healed although there is some residual scar. The previous areas of vasculitis do still have some superficially open areas of skin, but there is no purulent drainage and these do not look frankly infected at this time. The right knee is slightly swollen when compared with the left; however, there is no joint line tenderness and she is able to perform range of motion of approximately 70-80 degrees. She is not able to extend completely. SUMMARY AND IMPRESSION: Janice appears to have improved with respect to her systemic infections. In fact, she does not appear to have ongoing systemic infection at this time. Given her inadherence I am worried with regards to the ongoing nature of indwelling prosthetic material. Specifically, she continues to have a PICC line and a percutaneous drain and I am worried that these may serve as sources of secondary infection in the future. I have therefore discontinued not only her antibiotics but as well her PICC line and her subdeltoid drain at today's clinic visit. I believe that the ongoing skin erosions from the previous areas of vasculitis can be managed with topical therapy alone. I note that she is not particularly adherent with her prednisone therapy and yet does not seem to have

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