Intramuscular Injection Abscess Due to VRSA: A New Health Care Challenge

Document Type : CASE REPORT


1 Department of Orthopaedics, K.G. Hospital and Postgraduate Medical Institute, Arts College Road, Coimbatore, Tamil Nadu, India

2 Princess Alexandra Hospital, Harlow, UK

3 VCU Medical Center Ambulatory Care Center. 417 North 11th Street, Richmond, Virginia, USA


Abscess formation following intramuscular injections is rare and they are most commonly seen in immunocompromised individuals. In this case series we present a cohort of three patients presented to us in a critically ill condition with an abscess due to intramuscular injection. Vancomycin resistant staphylococcus aureus was isolated from all three patients. These patients posed a major challenge to the healthcare system and the treating physician because of the: severity of illness, virulence and resistance of the organism, rarity of the situation, immune state of the patient, and lack of supporting evidence to properly guide management in the use of health resources. To the best of our knowledge, there is no report available in the English literature on vancomycin resistant staphylococcus aureus associated with intramuscular injection abscess.


1. VelissarisD, Matzaroglou C, Kalogeropoulou C,
Karamouzos V, Filos K, Karanikolas M. Sepsis requiring
intensive care following intramuscular injections: two
case reports. Cases J. 2009; 2(1):7365-70.
2. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE,
McDougal LK, Carey RB, et al. Methicillin-resistant S.
aureus infections among patients in the emergency
department. N Engl J Med. 2006; 355(7):666-74.
3. Abdulla Hawramy T, Saeed KA, Salih Ahmed BH. Gluteal
abscess, different intramuscular drug injections as
causative agents. 3rd International Conference of
Medical Sciences, Dubai; 2012.
4. Greenblatt DJ, Allen MD. Intramuscular injection-site
complications. JAMA. 1978; 240(6):542-4.
5. Hare R, Thomas CG. The transmission of
Staphylococcus aureus. Br Med J. 1956;
6. Srinivasan A, Dick JD, Perl TM. Vancomycin
resistance in staphylococci. Clin Microbiol Rev. 2002;
7. Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover
FC. Methicillin-resistant Staphylococcus aureus
clinical strain with reduced vancomycin susceptibility.
J Antimicrob Chemother. 1997; 40(1):135-6.
8. Smith TL, Pearson ML, Wilcox KR, Cruz C, Lancaster
MV, Robinson-Dunn B, et al. Emergence of vancomycin
resistance in Staphylococcus aureus. Glycopeptide-
Intermediate Staphylococcus aureus Working Group.
N Engl J Med. 1999; 340(7):493-501.
9. Tenover FC, Lancaster MV, Hill BC, Steward CD, Stocker
SA, Hancock GA, et al. Characterization of Staphylococci
with reduced susceptibility to vancomycin and other
glycopeptides. J Clin Microbiol. 1998; 36(4):1020-7.
10. Tiwari HK, Sen MR. Emergence of vancomycin
resistant Staphylococcus aureus (VRSA) from a
tertiary care hospital in northern parts of India. BMC
Infect Dis. 2006; 6:156-62.
11. D’Agata EM. Antimicrobial-resistant, Gram-positive
bacteria among patients undergoing chronic
hemodialysis. Clin Infect Dis. 2002; 35(10):1212-8.
12. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman
HM, Mélot C, et al. C-reactive protein levels correlate
with mortality and organ failure in critically ill
patients. Chest. 2003; 123(6):2043-9.
13. Moise PA, Forrest A, Birmingham MC, Schentag JJ.
The efficacy and safety of linezolid as treatment for
Staphylococcus aureus infections in compassionate
use patients who are intolerant of, or who have failed to
respond to, vancomycin. J Antimicrob Chemotherapy.
2002; 50(6):1017-26.
14. Woodford N, Livermore DM. Infections caused
by Gram-positive bacteria: a review of the global
challenge. J Infect. 2009; 59(Suppl 1):S4-16.
15. Morykwas MJ, Simpson J, Punger K, Argenta A,
Kremers L, Argenta J. Vacuum-assisted closure: state
of basic research and physiologic foundation. Plast
Reconstr Surg. 2006; 117(7 Suppl):121S-6.
16. Rossi L, Conen D. Intramuscular injections--
an outdated form of administration? 6 cases of
Staphylococcus aureus sepsis following intramuscular
injections. Schweiz Med Wochenschr. 1995; 125(31-
multidisciplinary approach from various specialists for
satisfactory outcome.