mrsa!

In clinical last Thursday I had the pleasure of seeing my very first suspected MRSA! MRSA is strain of staphylococcus aureus that is resistant to a standard antibiotic, methicillin, as well as other commonly used antibiotics such as penicillin, oxacillin, and amoxicillin. MRSA has been around NYC for some time now , and recently has been seen more and more in children; daycare facilities have been cited as places the infection can spread rapidly.

Prior to the past five years, MRSA was rarely seen outside the hospital, and infections were predominately found in immunocompromised people. However, since then, community acquired infections (CA-MRSA)have increased dramatically, and crowded cities like NYC have seen the biggest rate of infection. MRSA can linger in the nose, blood, urine, and on the skin. Generally the infection is transmitted among people who share personal items (razors, towels, athletic equipment). CA-MRSA typically manifests as boils or pimples.

Which brings me back to my patient. He presented with an abscess that had been pimple-like less than 48 hours ago, but in that short period had expanded into a one inch in diameter abscess surrounded by a large, reddened, indurated area about 3" by 5". My preceptor told me MRSA's nicer cousin, methicillin-suseptible staphylococcus aureus (MSSA), usually presents as a nice clean abscess you can drain without difficulty. MRSA, she said, presents like this: a hardened area where much of the pus has seeeped into the surrounding tissue. Think of it as the difference between using a needle to pop a water balloon vs using one to drain a sponge, she told me. Great. We gave him some Lidocaine and drained what we could before sending him off with Bactrim and the specimen to the lab. Fun update: the culture came back MSSA. Ah, well.