This patient should be treated with vancomycin. Hospital-acquired skin and soft-tissue infections should be treated as a methicillin-resistant Staphylococcus aureus (MRSA) infection until culture results are received and therapy can be tailored appropriately. Hospital-acquired skin infections are increasingly caused by MRSA, and coverage against this organism in the hospital setting is important to prevent further morbidity and mortality, particularly in high-risk patients. Once culture and sensitivity results are known, antibiotic therapy can be focused toward a specific organism. In the patient described here, a local abscess and surrounding cellulitis with corresponding fever and leukocytosis suggests the potential for systemic involvement.

Amoxicillin-clavulanate should not be used because these antibiotics do not provide coverage against MRSA organisms.

Similarly, cephalexin is often effective against multiple skin and soft-tissue infections and may be considered first-line therapy for an abscess and cellulitis in the ambulatory setting; however, it too is ineffective against MRSA.

Although meropenem is a potent antibiotic with broader antimicrobial coverage, it is not effective against MRSA infection and thus would not be an appropriate choice for this patient.

Several strategies may be used to attempt to reduce rates of MRSA infection in hospitalized patients. Routine screening and active surveillance cultures for MRSA colonization are obtained in some institutions to identify carriers and to guide use of contact precautions and possibly attempted decontamination with intranasal mupirocin. However, the efficacy of this practice is not clear except in the setting of an acute outbreak. Daily chlorhexidine bathing has been shown to decrease the risk of colonization and infection with drug-resistant and other organisms in ICU settings.