CAUSATIVE ORGANISMS

• Primarily S. aureus
• Less often: Group A strep, Strep pneumonia, and gram negative enteric bacteria​

RECOMMENDED TREATMENT

1. MRI recommended for establishing diagnosis, CT scan and ultrasounds also may be useful if patient cannot get a MRI
2. Blood cultures and culture of abscess recommended
3. Incision and drainage of abscess recommended
4. ANTIBIOTICS
   • ​Vancomycin
   • If patient is immunocompromised or had open trauma to the muscle, add one of the following to vancomycin
     1. Piperacillin/tazobactam 3.375 g IV q8
     2. Ampicillin/sulbactam 3 gm IV q6h 
     3. Meropenem 1 gm IV q8h (requires ID approval)
   • Antibiotics should be altered according to culture results and continued IV until the patient shows clinical improvement.  At that time, antibiotics may be changed to PO if bacteremia cleared promptly and there is no evidence of endocarditis or metastatic abscesses. Repeat imaging in persistent bacteremia. Duration of therapy is 2-3 weeks total.