The chart said the patientís problem today was a painful spider bite. It seemed a little unlikely to me, because I donít see too many of the creepy critters in mid-January, but I agreed to take a look.
What I found was a big angry red bump on the patientís lower back. It was about the size of a half-dollar and very tender. Right in the center was a pustule (the medical term for a zit). A brief discussion with the patient revealed this had happened to his spouse a couple of weeks before.
Was it a spider infestation? Not quite. This is the one of the commonest presentations of a different kind of critter Ė a microscopic one Ė known as community-acquired MRSA.
MRSA stands for methicillin resistant staph aureus. This antibiotic-resistant bug first appeared years ago in hospitals. Itís still there. Unfortunately, the bug has become so common that it made the jump to the community setting.
MRSA has also become so common that it is now one of the leading causes of skin and soft-tissue infections.
As with its cousin, staph aureus, once exposed, a person can carry this bacteria on the skin without knowing it. However, MRSA is a bit more potent and can take advantage of minor skin injury to enter the soft tissue and cause deeper infection.
Sometimes, MRSA starts as a pimple and may resolve without treatment. Other times it may begin as, or evolve, to become a deeper infection under the skin. The resulting red, painful, hard bump is frequently mistaken for a spider bite.
Left unattended, the infection may abscess, forming a pocket of pus (also known as a boil). Sometimes, pus will spontaneously drain. Not uncommonly, it becomes necessary for the doctor to drain the abscess using a scalpel blade (after injecting a local anaesthetic to numb it).
The earlier MRSA skin and tissue infections are diagnosed, the better. I have seen abscesses become quite large and deep. These are more difficult to treat and take longer to heal.
Even though MRSA is resistant to some antibiotics, thankfully, MRSA infections can still be treated with other types of antibiotics when needed. For small abscesses, sometimes scalpel drainage is all that is needed.
People with weakened immune systems may be more susceptible to recurrent MRSA infection. This includes people on immune suppressing drugs, those with chronic illness and the elderly.
Of course, the whole problem with resistant bacteria began with, and continues to be, the overuse of antibiotics. These powerful drugs should be saved for true bacterial infections in situations where they have been shown to benefit.
The decision about when to use antibiotics should be part of an honest conversation with your health-care provider.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.