A patient comes in with a small cut on their leg. At first, it doesn’t look like anything serious. But a few months later, they’re back—now the area is red, painful, and swollen. The cut has become infected. What started small turned into something more serious: cellulitis, a skin infection that can be hard to see coming.
Dr. Amanda Novack, an infectious disease specialist at Baptist Health, helps us understand what MRSA and cellulitis are, what signs to watch for, and how to treat these infections.
Cellulitis and MRSA Defined
Cellulitis is a skin infection that happens when bacteria get into the deeper layers of skin, often through a cut or scrape. One of the more serious causes of cellulitis is a bacterium called MRSA (short for Methicillin-resistant Staphylococcus aureus). MRSA is hard to treat because it doesn’t respond to many common antibiotics.
MRSA often spreads through contact with infected skin or surfaces, making it difficult to know exactly where someone picked it up. Places like hospitals, clinics, gyms, or anywhere someone might get a cut or scrape can increase the risk if wounds aren’t properly cleaned.
Trends in Arkansas
In Arkansas, MRSA is common, especially the type acquired in the community, not just in hospitals. This kind of MRSA, called community-acquired MRSA (CA-MRSA), often causes skin problems like boils, abscesses, or more serious infections that can require a hospital visit.
“We’re seeing these CA-MRSA infections in individuals without traditional healthcare-associated risk factors,” Dr. Novack says. “The infection presents as boils, abscesses, or more extensive cellulitis.”
Even if someone hasn’t recently been in the hospital or taken antibiotics, they can still contract MRSA—especially if they have a painful, pus-filled lump or if standard treatments haven’t worked.
Key Warning Signs
When Dr. Novack sees a patient with cellulitis, there are a few warning signs that make her think MRSA is the cause. Here’s what she looks for:
- Pus or drainage: This is the biggest clue. If there’s a boil, abscess, or any kind of draining lump, it often means a staph infection is present, and in Arkansas, that’s often MRSA.
- History of previous MRSA infection: There is a significant risk of recurrence if a patient has had a previous MRSA infection.
- No improvement with antibiotics: If a patient with presumed cellulitis isn’t getting better after a few days on a common antibiotic like cephalexin or amoxicillin-clavulanate, MRSA should be high on a doctor's radar.
- Signs of more severe infection: If a patient experiences fever, chills, or significant pain outside of the norm, these are signs of rapid progression of the infection to the deeper layers of skin.
- Certain risk factors: While not a sure sign, factors like injecting drugs, recent jail time, or playing close-contact sports can increase the likelihood of MRSA.
Why Some People Are More Likely to Get MRSA
MRSA can affect anyone, but certain people are at higher risk based on where they live, work, or play—or because of underlying health issues. Dr. Novack highlights common situations in Arkansas where MRSA risk increases.
Close-contact activities
People who play more contact sports like football or wrestling often deal with skin-to-skin contact, shared gear, and small cuts, making it easier for MRSA to spread. This includes many high school and college athletes in Arkansas.
Outdoor workers and rural residents
Farming, gardening, and other outdoor activities can lead to minor injuries, like scrapes, insect bites, or puncture wounds. These can be entry points for bacteria if not cleaned properly.
“These infections can become complicated or secondarily infected with MRSA,” Dr. Novack explains.
In rural areas, delayed access to care can make infections worse. People may wait too long to treat a skin infection, increasing the risk of serious complications.“By the time patients present at the clinic, their likelihood for needing broader antibiotic coverage, including for MRSA, is greater,” she says.
People who inject drugs
MRSA is common in people who inject drugs due to frequent skin punctures and the potential for contamination. Avoiding drug use is the best prevention method to avoid skin infection.
Congregate living settings
Living in close quarters, such as prisons or long-term care facilities, increases the risk of skin infections. These environments often involve frequent close contact, shared surfaces, and limited access to personal hygiene supplies.
Chronic skin conditions and diabetesPeople with conditions like eczema or psoriasis have damaged skin barriers, making it easier for bacteria to get in. People with diabetes are also more likely to get skin infections, and those infections can be serious or harder to treat if MRSA is involved.
Why Pus Matters in Skin Infections
Whether or not a skin infection has pus (often called purulence) or not can tell doctors a lot about what’s causing it and how to treat it.
No pus? It’s probably strep.
Most cases of cellulitis that don’t have pus are caused by a type of bacteria called Streptococcus. These infections usually respond well to a common group of antibiotics called beta-lactams.“Sometimes, providers take a ‘better safe than sorry’ approach by covering for MRSA in non-purulent cellulitis, but that often means using an inferior antibiotic that is not actually safer for a patient,” Dr. Novack says.
In short: If there’s no pus, MRSA is less likely—and using the right kind of antibiotic is more effective.
Pus present? Think MRSA.
When there is pus, the infection is more likely caused by Staphylococcus aureus—and in Arkansas, a lot of these cases are MRSA.
“The primary treatment for localized purulent infections is I&D,” Dr. Novack says. “So recognition of purulent cellulitis is important both for source control and the choice of antibiotics for adjunctive therapy.”
In other words: If there’s pus, draining the infection is the first step. Then, antibiotics can be used to support healing.
So, when doctors are deciding on treatment, the presence or absence of pus helps them choose the right path:
- No pus = likely strep (use beta-lactams)
- Pus = likely staph, often MRSA (drain and treat with the right antibiotic)
Final Thoughts
MRSA and cellulitis are more common—and more complicated—than many people realize. By understanding the signs, knowing who’s most at risk, and taking steps to protect even minor wounds, we can catch these infections early and avoid more serious health problems. In Part 2, we’ll explore how providers can better diagnose and treat these infections, avoid common pitfalls, and stay ahead of growing antibiotic resistance.
