A Fifteen Month Old With A Buttocks Abscess

1/24/2008

I recently treated a fifteen month old who presented with a painful reddish swelling of the right buttocks. The involved area had a puslike head to it and could be well defined when examined. The child had a fever of 103 degrees Fahrenheit for 24 hours prior to coming in. I chose to do a CBC in order to decide how aggressive to be in his treatment. The white blood cell count was 14K with a large predominance of the cells being polys (the more bacterial tendency type of cells).

I decided to drain this nasty looking abscess in the office. A large amount of thick puslike material was removed. The fluid was sent to the lab for a bacterial culture. The child was put on an oral antibiotic (Augmentin). The mom was instructed to apply frequent warm compresses as well as warm water baths. A topical antibiotic cream was used as well. The fever resolved within 36 hours and the swelling came down dramatically. The mom was also instructed to put the child on a two-three week course of probiotics to help restore the gut bacterial flora after an antibiotic course.

The culture came back reporting Staphylococcal bacteria of the MRSA type. The report stated that the bacteria were not sensitive to the antibiotic prescribed. Despite that report, the child improved dramatically and required no further treatment. This reinforces the clinical care parameters established that in most cases an individual of normal immune status can be treated for MRSA without any significant risk. MRSA can be very aggressive in the very young, very sick and very old as their immune systems are not working maximally. In this case a simple drainage followed by oral antibiotics did the trick. The lesson for all is not to panic when MRSA is diagnosed. Seek out good medical care and advice and don’t treat a lab result, treat the patient!

      

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