A new idea about handling MRSA, and a comment on the differential diagnosis of infectious cellulitis.

Isolation wards for controlling MRSA

Regarding the article on methicillin-resistant Staphylococcus aureus (MRSA) in the July issue of ACP Hospitalist (“More hospitals fight MRSA with universal screening”), has anybody considered isolating all of the MRSA patients to one (or perhaps more than one) “isolation” ward?

By doing this, one would not need to gown and glove before entering the patient's room, but only upon entering the isolation ward. The patients would benefit because the physicians, nurses and ancillary personnel would have a much easier time accessing them, and so they would be less likely to experience preventable adverse events.

CDCslashScience SourceslashPhoto Researchers Inc
CDC/Science Source/Photo Researchers Inc.

Since we all know (but few actually practice) effective hand-washing, the nurses and other staff working on this isolation ward would be the experts on hand-washing technique. They could be assigned fewer patients per nurse, so that they could be more effective in decreasing the spread of MRSA. By isolating the MRSA patients to one floor, the spread of infection to non-MRSA-infected or -colonized patients would obviously be reduced.

Somebody needs to think “outside the box,” as what the medical community is doing now is not working.

Daniel R. Collins, MD
San Diego

Differential diagnosis of infectious cellulitis

In July's MKSAP primer (“Cellulitis, necrotizing fasciitis and toxic shock syndrome”), diabetic myonecrosis was an important consideration left unmentioned in the differential of “red” skin masquerading as infectious cellulitis. I have seen two MRI-documented cases of this entity in the past two years in our hospital, and both times patients were treated with a prolonged course of antibiotics unnecessarily. Diabetic myonecrosis is presumed to be an ischemic-mediated death of muscle cells. A dramatic symptom that raises the possibility of this disease is exquisite pain with movement of the involved muscle group. In our cases, both were in the thigh. The pain severity is reminiscent of the excruciating exacerbation of necrotizing fasciitis pain when one touches the involved area; the person with myonecrosis has a similar exacerbation with movement of the affected muscle group.

Mark Anisman, ACP Member
Yountville, Calif.