AHRQ Case and Commentary: Challenges of Recognizing and Managing MRSA among Athletes

Physicians of athletes presenting with possible spider bites and other abscesses should maintain a high degree of suspicion for the presence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), according to the author of a commentary from the October 2012 edition of the Agency for Healthcare Research and Quality’s (AHRQ) online case study review, WebM&M. In the spotlight case, a 16-year-old wrestler presented to his pediatrician with a lesion on his left buttock. The pediatrician incised the lesion, prescribed oral antibiotics (clindamycin), and scheduled a follow-up appointment for seven days later. Four days after the appointment, the wrestler complained of hip pain and chills, which prompted his mother to take him to the emergency department. Despite deep-tissue debridement and appropriate antibiotics, he developed acute renal failure necessitating peritoneal dialysis, respiratory failure requiring intubation, and damage to his femur requiring a full hip replacement. Results from the wound culture revealed community-acquired MRSA resistant to clindamycin. According to the author, this case illustrates potential opportunities for patient and athletic team education toward prevention and recognition of this disease as well as some of the challenges in management of MRSA skin and soft-tissue infections.