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michaelemery 03-24-2010 05:54 AM

Worried about deep inguinal staph abscess
I'm new to the board a looking for some help/information if possible. I had an abscess removed surgically from my right hip one week ago on 03/16/10. I thought it looked like an inguinal hernia as far as location goes after it appeared 03/12/10 but it was growing daily, was red and tender, and was hard. I saw 2 physicians 03/15/10 and had 2 images (doppler/CT) and surgery was scheduled the next day as a lymph node was enlarged. I was informed the suspicious lymph node was located on an abscess. These were reported to me to be deep, and were removed and biopsied, and I was informed this was negative for cancer and positive for Staph infection "don't worry, not the MRSA kind". I am allergic to flouroquinolones, so was placed on Augmentin, had 2 hives break out, and was switched to the generic med for Bactrim. So the incision was closed with dermaglue and stitches, no drain, and now one week later the area just below the surgical site is getting larger, hard and tender again. I have 3 worries:
1. The infection is still there.
2. The infection could spread to my bone, heart valves, bloodstream.
3. Now a second abscess has formed and will need surgery to remove it again.
I am going to see the surgeon again for a followup and I was wondering about ANY suggestions you have in the meanwhile. Things I could ask the doctor, should I have a drain put in, is Bactrim not working, I don't know anything the collective expertise on this board can offer.
Thanks so much for all your help. By the way, I am 34 years old with no other health issues to speak of.

Mari526 03-24-2010 01:42 PM

Re: Worried about deep inguinal staph abscess
It sounds like the abcess didn't resolve with the antibiotics ordered. A closed over incision presents a problem because it holds in the infection.
You should call your doctor, he'll probably want to see you sooner.

harka 03-25-2010 07:17 AM

Re: Worried about deep inguinal staph abscess
When staphylococcus is NOT MRSA (i.e. it's MSSA) it's best treated with either cloxacillin (by mouth or IV) or cephalexin or cefazolin. Augmentin which is amoxicillin/clavulanate is not the best choice. Other antibiotics CAN be used for Staph infections such as Septra (bactrim in the States), and it's a good drug for staph, though it's generally saved for patients with MRSA. Clindamycin is another good one. Fluoroquinolones have anti-staphylococcal activity but should NEVER be used alone as resistance can develop quickly.

I see you've been doing some reading about Staph. Excellent. Yes staph can enter your bloodstream and from there it can seed your heart valves, bone etc; however, if you're otherwise healthy and you don't have an actual central venous catheter (i.e. an indwelling intravenous line to one of your larger veins), the chances of it going to your blood are much less.

It's possible that after any surgical drainage, you may just need a longer course of antibiotics, or another option is to give you something intravenously. Generally for Staph which is methicillin sensitive (i.e. MSSA) we use cloxacillin or cefazolin IV here in the States they often use dicloxacillin, oxacillin, naficillin (instead of clox) and they also have cefazolin. Augmentin can be used to treat Staph, there're just better choices.

I wonder, though, if your doctor gave you augmentin because of the location of the lymph node. Any infection located in the inguinal region has the possibility of being contaminated with stool organisms (even if you're a clean person! :). Anyway, I hope you start to feel better soon.

michaelemery 03-27-2010 02:22 PM

Re: Worried about deep inguinal staph abscess
Thank you for your time and expertise! Wow, let's just say I can tell I came to the right place for information....

Here's an update: I had a followup with the surgeon and he informed me the lump I see/feel is a healing ridge. It may seem feasible I suppose as the lump does follow the incision site pretty specifically. He informed me it was from the dissolution of the stitches and was due to how deep the surgical procedure was. It feels to me like a hard, good sized pencil buried beneath the scar that is not mobile when I try to move it. It is a very obvious deformity and is still slighty tender when I push on it. There is not a lot of redness but it is a little warm. It's still pretty big though. I asked him if we should drain it and he told me there was no need unless I had more swelling or redness that was conspicous other than the presence of that healing ridge. My main concerns at this point are:
1. The size of the lump on the inner crease of my hip. Although I could care less about scarring, it just looks as big as before surgery. BTW, the abscess was the size of a large marble, and the enlarged lymph node was the size of a very small grape. His told me the appearance was normal, wondering your thoughts?
2. I have just about completed my 10 day course of antibiotics. What do I do to make sure the staph is gone then, as the lump has shown no evidence of subsiding in size? I don't want to discontinue the medication and just assume I'm good to go? What's the typical procedure there?

Any suggestions are just greatly appreciated, thank you again in advance for your time!!

harka 03-31-2010 09:33 AM

Re: Worried about deep inguinal staph abscess
One thing that one has to remember when diagnosing skin and soft tissue infection is that when you are doing it from palpation and visualization alone, you are using SURROGATE markers of infection rather than infection itself. The gold standard of diagnosis of a skin infection is to take a biopsy of the skin, look under the microscope and actually see the bacteria invading the skin structures. However, you can't do this in everyone so instead, you look at the skin for typical signs of inflammation (i.e. redness, swelling, heat and discharge) to make the diagnosis. Most of the time, when you see these signs of inflammation on the skin, they represent signs of infection, but not always. There are skin conditions like pyoderma gangrenosum which also have extensive inflammation of the skin, but these conditions are NOT infectious.

That said post-operatively, there can be lots of inflammation in the skin in the absence of infection. The hardness you describe is something that is common in surgical wounds and does represent inflammation but not infection. As long as things are not significantly worsening and you are systemically well (i.e. no fevers, serious malaise, rigors etc) things should be fine.

Especially with extensive surgical manipulation of an area, induration can be present for a long time afterwards!

michaelemery 04-02-2010 08:31 AM

Re: Worried about deep inguinal staph abscess
Thanks! Okay here's a quick update. Everything was going fine until I did spike a fever yesterday 03/31/10: 99.7 that did quickly absolve with one dose of acetaminophen. I did eat some bad tasting Taco Bell the night before and have significant gastrointestinal symptoms i.e. bloating and diarrhea and all of these symptoms did literally last one evening and the following morning. Now, I am an average or above average "worry wart" and so I did call the doctor and they informed me I could schedule an appointment with the doctor but it was not necessary. I am tempted to see him for another followup even though I no longer have a fever and the incision is only slightly warm, and not really red. I asked about another dose of antibiotics (over the phone with my surgeon's nurse) and I was informed that a 10 day dose is substantial and usually sufficient. I am going in to see the physician next week and I will keep you posted.

In addition, harka, you should be a teacher if you aren't already. Your explanations are concise and easy to interpret. Your expertise and ability to relate that information from my experience is pretty rare. Truly, thank you for your time, I am learning more from this board than all of my online research combined!

harka 04-03-2010 08:33 AM

Re: Worried about deep inguinal staph abscess
Thanks very much could say that I'm a teacher already ;)

I'm glad things are looking up for you. I am also very glad the nurse didn't give you antibiotics "on spec" because there are so many other reasons for a fever and giving antibiotics is not the solution. In infectious diseases it's always necessary to ask WHY is the fever happening. Many cases of endocarditis (an infection of a heart valve) have been obscured because of doctors giving antibiotics for a fever without knowing where it was coming from.

Please keep us up to date as to how you're feeling!

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