Dangerous Skin Infections Hit Home
THE DOCTOR'S OFFICE
OCTOBER 15, 2008
By BENJAMIN BREWER, M.D.
My 25-year-old patient tried to ignore his swollen right knee. But the redness and throbbing pain from a skin infection kept getting worse.
After two days of gutting it out, the strapping construction worker showed up in my office with a large abscess on his right leg and a new one starting on his left foot.
An infection was spreading through the surrounding skin, and I had to drain the wounds surgically. A sample I sent to the lab showed the infection was caused by bacteria that are resistant to some of the most commonly used antibiotics.
After treatment with both IV and oral antibiotics, the wound healed in about two weeks.
Infections like this patient's are caused by a nasty bug we call Methicillin-Resistant Staphylococcus aureus, or MRSA. The bacteria, and the infections they can cause, used to be confined mostly to surgical wounds in hospitals and chronic wounds in nursing homes. But now the same tough-to-kill bacteria are occurring in the community, and I'm seeing a lot more of them.
About 85% of MRSA infections can be traced back to a hospital stay and two-thirds occur after a patient has arrived back home. But 15% of the infections can't be linked to a hospitalization. That was the case for my construction worker.
Initially, many patients mistake the infection for a spider bite. The infection forms spots that look like pimples or boils, and it can deepen and then spread. Most of the time simple surgical drainage is all that's needed, but other times it becomes invasive and goes painfully deep into the surrounding tissues and even the blood stream.
A diabetic man in his 50s developed a MRSA infection on his chin last year. We think a nick from shaving might have started it. The resulting infection spread from his chin to the inside of his mouth. He developed another infection under his arm this year and had to have a surgeon drain it.
We all harbor skin bacteria. Some bugs are worse than others. About 25% to 30% of people carry staph bacteria on the skin or in the nose and can pass it to others. Only about 1% of the population is walking around with MRSA.
Even so, nearly 18,650 people died from MRSA infection and 94,000 others were seriously sickened in 2005, according to the Centers for Disease Control and Prevention.
Prevention is better than treatment. Finding drugs to cure MRSA infections is a challenge. Bacteria eventually outwit the antibiotics we throw at them. And there's always a need for new weapons against the resistant bugs.
But antibiotics are taken only for short periods and aren't as profitable to drug makers as those prescribed for a lifetime to treat or prevent a chronic disease. It has also proved difficult for scientists to develop new types of medicines to thwart the bacteria. As a result, we have few new antibiotics to choose from.
For some of my patients recurring infections present a real challenge. The dry, flaky and irritated skin of an 18-month-old girl with eczema is more than a painful irritation. It's also an open route for MRSA she carries on her skin to reach deeper tissues. The toddler already has multiple scars on her legs from the boils that form below the skin. Most break open and drain after a few days. But some of the larger ones have needed my intervention.
The girl's mother now bathes the girl in a solution of diluted bleach to disinfect her skin. That approach, recommended by her allergist, has helped cut down on the infections.
The basics of MRSA prevention are hand washing, wiping down surfaces and covering cuts. Keeping personal care items separated from others also helps. For more information on MRSA and how to prevent its spread, see this report from the Mayo Clinic.
mayoclinic.com
MRSA spreads easily in close quarters like classrooms, locker rooms and lunch rooms. I've seen several cases from tanning beds. Athletes should shower right after practice. The same goes for anyone using shared equipment at the gym.
The CDC has voiced concern that antibacterial cleaning products may be making the situation worse by spurring the resistance of germs.
Around the office, we're relying on disinfectants like bleach more than antibacterial cleaners. We're washing hands and wiping down surfaces after each visit.
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