Abscess (ER Story)

“So washing two or three times
a day [in] an area that looks infected, and using some antibiotic ointments,
can really eradicate may of these infections early on.”

– Dr. David Goo, Emergency Pediatrics,
Children’s Healthcare of Atlanta

In the rough and tumble play
of childhood, sometimes kids get a scratch or a cut so minor they
won’t even remember how it happened. But that cut can be
the beginning of something far more serious.

That’s what happened to one-year-old Alison, who entered
the ER with pain and a high fever. She has a boil –or rising–
on her right buttock.

“Okay, and how long has she had a problem with this rising?” asks
Dr. David Goo, Emergency Pediatrics at Children’s Healthcare
of Atlanta.

Her mother says it’s been hurting for a few days.

“Has she been more irritable, crying, fussier than normal?” asks
Dr. Goo. “Yes, crying. Fever, burning up,” says her
mother.

Dr. Goo says the boil became infected, and is now causing extreme
discomfort. “And you could tell that it was hard, and warm,
and red, and very, very painful. [And] it had some pus inside of
it.”

It probably started out as a scratch, a bug bite or a minor cut.
But bacteria entered the wound, and an abscess developed that will
have to be drained.

“Okay, let’s turn her over,” Dr. Goo tells
his assistants in the exam room, as they prepare to drain the abscess.
After the procedure, Dr. Goo says, “The pediatric surgeons
will admit her overnight to watch her carefully.”

Tests reveal the culprit. Bacteria called MRSA… methicillan
resistant staph. It’s a dangerous germ that is becoming more
commonplace.

“It’s becoming really an epidemic in the community,” warns
Dr. Goo. “In fact, we’ve had a couple of children die
here from staph infections, methicillan resistant staph in their
blood.”

He says whenever a child gets a minor cut or scratch, the best
first step is soap and water and Neosporin.

“So washing two or three times a day [in] an area that
looks infected, and using some antibiotic ointments, can really
eradicate many of these infections early on.”

As for Alison, she’s much better after a night in the hospital.
The next morning, her fever is just about gone.

Dr. Goo cautions her mom, “We have to be very careful about
these sores. So if she gets another sore you have to take her right
to her doctor, or come to see us. Because we don’t want it
to be infected again.”

A staph infection is actually the staphylococcus aureus bacteria. According
to doctors in the Columbia University Medical Center, common minor (or
relatively minor) skin infections caused by staph include:

• Folliculitis – Infections of hair follicles that cause
  itchy white pus-filled bumps on the skin (often where people
  shave or have irritations from skin rubbing against clothes).
• Boils – Infections deeper within hair follicles that
  leave large, frequently red inflammations (often occur on the
  face or neck).
• Sties – Infection of the follicle surrounding the eyelashes,
  causing a sore red bump in the eyelid.
• Impetigo – The infection kids often get around their
  mouths and noses that causes blisters and red scabby skin.
• Abscesses – Infection characterized by pus and swelling
  that can occur in the skin and in any other organ.

Staph infections are very common, so much so that many people don’t
know they have one. They can infect any part of the body and usually enter
through an open cut. The best way to treat staph infections is by administering
antibiotics, which are used to fight many bacterial infections. However,
the American Medical Association suggests using caution with any type of
medicine and has provided a list of things to know before using antibiotics.

• Antibiotics do not work against all infections. Antibiotics
  work only against infections that are caused by bacteria. These
  drugs are not effective at all against most viral infections.
  This is why your doctor will not always prescribe an antibiotic
  if you have an infection. Some antibiotics are effective against
  only certain types of bacteria. Others can effectively fight
  a wide range of bacteria. Bacterial infections include strep
  throat, most ear infections and some sinus, bladder and lung
  infections.
• Most common infections – such as colds, bronchitis and
  sore throats – are caused by viruses. Antibiotics should
  not be used for these viral infections because they don’t help.
  In fact, they may cause side effects, and overuse of antibiotics
  contributes to the growing problem of bacterial resistance. Some
  viral infections such as herpes infection, some cases of influenza
  and HIV/AIDS can be treated with antiviral drugs. Based on your
  illness and symptoms, your doctor can determine if prescribing
  an antibiotic is appropriate. Your doctor will then select the
  antibiotic that will work best for your infection.
• Antibiotics may cause side effects. If your doctor prescribes
  an antibiotic, be sure to ask him or her what possible side effects
  are possible. Antibiotics can cause nausea, diarrhea and stomach
  pain. In some people, an allergic reaction can occur. Some antibiotics
  kill naturally occurring bacteria that are needed by the body.
  These “good” bacteria are then replaced by bacteria
  that can cause diarrhea or yeast infections. If you experience
  any side effects when you are taking an antibiotic, you should
  call your doctor.
• Bacteria can become resistant to an antibiotic that was previously
  effective. Resistance is most likely to develop after long-term
  treatment with an antibiotic or with antibiotics that kill a
  wide variety of bacteria. Resistance is a growing problem, and
  there is concern that some types of infections will eventually
  not be treatable with antibiotics. This resistance is ascribed
  to overuse of antibiotics, especially for common viral infections.
• It is very important that antibiotics be taken as prescribed.
  Antibiotics should only be used when prescribed by your doctor.
  Consult with your doctor before taking any other medications
  (including over-the-counter medications). You should never take
  antibiotics given to you by someone else or prescribed for a
  previous illness.
• The dosage is a very important factor in antibiotic effectiveness.
  If the dosage of the antibiotic is not adequate, it will not
  be effective for treatment of the infection and bacteria are
  more likely to develop resistance. This is because the bacteria
  can continue to grow and develop ways to disrupt the antibiotic’s
  effects.
• Antibiotics must be taken for the full amount of time prescribed
  by your doctor. Many times, patients will stop the use of an
  antibiotic when they begin to feel better and it seems that the
  illness has gone. However, even after the symptoms are gone,
  the bacteria may still be present in small amounts and an infection
  can return if use of the antibiotic is stopped. Not completing
  the prescribed dose may also promote resistance.
• Antibiotics should not be saved and reused. You should always
  take the full course of antibiotic treatment, so none of the
  drug should be “left over.” However, if this has occurred,
  the antibiotics should not be taken to treat any other illness.
  Different types of infections require different types of antibiotics,
  so taking leftover medications is often not effective.
• Always
  consult your doctor if you have an infection. Only your doctor
  can determine if you have an infection and the type of antibiotic
  that will be most effective and that is safe for you to take.

Children’s Healthcare of Atlanta
Children’s
Healthcare of Atlanta Emergency Services
American Medical Association
Columbia University Medical
Center
The Medem Network