Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Staphylococcal Infections Stasis Dermatitis 1375

follow-up

■For cases of bacteremia, may follow-up with blood cultures to ensure

that bacteremia is cleared off antibiotics

■Recurrence of bacteremia suggests wrong diagnosis (e.g., missed

endocarditis) or may necessitate removal of medical device (intra-

venous catheter, prosthetic joint).

complications and prognosis

Prognosis

■Generally good if localized disease

➣S. aureusbacteremia has a mortality rate of 10–40%; higher if age

>50 or more comorbidities; lower in catheter-related infections.

➣The mortality is lower for young intravenous drug users with

uncomplicated right-sided endocarditis; higher (20–45%) in the

other cases (older patients, left-sided disease, prosthetic valve

infections).

Prevention

■Elimination of nasal carriage (using Mupirocin) may be helpful in

preventing infection in high-risk populations (surgical or hemodial-

ysis patients or those with recurrent disease).

■Using hospital infection control principles, nosocomial infection

with Staphylococcus spp can be dramatically reduced.

STASIS DERMATITIS

J. MARK JACKSON, MD

history & physical

■History – swelling of lower extremity, pruritus

■Physical – erythematous, scaly, patches and plaques over edematous

skin, with or without hyper/hypopigmentation and lichenification.

Ulceration may occur as a consequence.

tests

n/a

differential diagnosis

■Cellulitis usually warm and tender with fever, unilateral (not always)

■Contact/irritant dermatitis