‘Pearls of wisdom’ for bacterial skin infection in primary care

During the PCDSI 2022 Annual Meeting, Dr Alana Durack, Consultant Dermatologist, University Hospital Waterford, gave her “pearls of wisdom” for encountering bacterial skin infection in primary care. 

“Common things are common,” said Dr Durack. “But it’s important to swab so you’ve got something to back up if the antibiotics aren’t working or the patient’s not getting better.” 

For example, with an impetigo, a superficial skin infection that occurs in bullous and non-bullous form, the latter of which can form a crust. “When there’s a lot of crusting it’s very easy to miss an underlying [herpes simplex virus] HSV infection,” said Dr Durack. “With those kind of things I think it’s always sensible to think about taking a swab for HSV as well as bacterial swab.” 

Her second pearl was about the importance of considering underlying viral infections, including HSV and varicella zoster virus (VZV), using the “red swabs” when conducting PCR tests. 

“Give the full clinical details on the request to microbiology,” she advised. “The more information you give, the better advice that you get back.” She advised including details like where on the body the sample is from, if the wound is surgical or not, or if the wound is contaminated. 

While Panton-Valentine leukocidin (PVL) staph infection is not common, it is important to consider the condition, according to Dr Durack. PVL staph is a “highly pathogenic staph strain”, that’s “often recurrent and… not so easy to clear”. 

“Microbiology are always available for advice if needed,” she said in her last point. “So it’s always helpful sometimes to just pick up the phone and get an opinion.” 

“The most common infections, globally, regardless of age or geographical location are staph and strep[tococcal] infections,” said Dr Durack.