Generally, skin infections tend to rank at the bottom of a patient’s priority list when seeking medical treatment.
Often, patients would rather purchase over-the-counter creams and/or antibiotics to self-medicate, rather than obtain professional advice.
However, the perils of underestimating simple skin infections can be severe.
Infections to the skin and soft tissue are primarily caused by a bacteria called Staphylococcus aureus (S. aureus). Often present in healthcare settings, S. aureus can even be found on the skin of about 30% of healthy people!
When a bacterial infection occurs, clinicians usually prescribe an antibiotic to get rid of the root cause.
However, due to increasing inappropriate or overuse of common antibiotics, bacteria that used to be eradicated with them are becoming resistant towards them.
MRSA (Methicillin-resistant S. aureus) refers to any type of S. aureus that is resistant to penicillins such as methicillin, oxacillin and flucloxacillin.
According to data, more than 50% of S. aureus infections are due to MRSA. Malaysia alone records a high incidence of 32%.
What is worrying is that whilst MRSA was initially a challenge within the healthcare setting, it is now fast becoming a problem within the community.
Increasingly more young people are seeking treatment for skin infections such as boils and pus-filled swellings. Most tests reveal that they have MRSA picked up from the community.
This is a potentially highly dangerous situation, as community-acquired MRSA may contain PVL (panton-valentine leukocidin) genes usually found in flesh-eating diseases.
Some MRSA patients even develop pneumonia and bloodstream infections – conditions that could endanger their lives and extend their stay in the hospital.
A number of risk factors can help to identify patients with suspected MRSA-related infection.
• Diabetes mellitus or kidney disease
• Intravenous drug usage
• Carbuncle/furuncle, dermatitis/chronic ulcers or abscess
• Antibiotic use eight weeks prior
• Previous MRSA infection or close contact with MRSA patient
• Hospital admission/surgery in previous year
Certainly, no one can relate to the consequences of MRSA better than Josh Lee.
Early this year, Lee developed an infect-ion soon after a surgery, causing his wound to swell and accumulate pus. Swab results confirmed that he had MRSA.
His prescribed antibiotics had no effect whatsoever, leaving him in severe pain.
Lee was unable to work and his quality of life suffered.
His prescription had to be changed twice due to recurrence, before he began to recover.
He had to use antiseptic solutions in his daily routine, and completely avoided sharing any personal items with other members of his family.
The same stringent care and hygiene was exercised by his family members.
Certainly, during this trying time, Lee did at times feel that he was living in isolation.
To date, Lee continues to carefully ma- nage his personal hygiene and lifestyle habits to ensure he does not get a recurrence of MRSA.
Lee’s experience emphasises the need for new and more potent antibiotics to treat MRSA.
The recent introduction of tedizolid phosphate, a next-generation oxazolidinone (a relatively new class of antibiotics), shows potential as a treatment option for serious skin infections such as MRSA.
The antibiotic is particularly viable because it only has to be administered once a day for six days (versus the usual 10 days), to deliver effective results.
In two major studies comparing tedizolid with linezolid (a type of antibiotic used to treat skin infections), not only did tedizolid demonstrate high eradication rates against infection-causing bacteria in a shorter time, it was also shown to be a safe and well-tolerated drug, with significantly lower related side-effects such as gastrointestinal disorders and low platelet count.
So, knowing how severe the consequences and burden of MRSA can be, I cannot emphasise this strongly enough – skin infections in any form, even simple ones, should not be taken lightly.
If your wounds are not healing properly, seek treatment as soon as possible.
Adhere to your doctor’s orders faithfully and go for follow-up sessions, which are very important to avoid recurrence.
Additionally, adopt good hygiene habits such as washing your hands frequently with soap or hand sanitiser to further prevent the spread of this emerging threat.
Remember, it is always better to be safe when it comes to matters of your health, even if it seems like an innocent infection.
Dr Chow Ting Soo is a consultant physician and infectious disease expert.