Flesh Eating Bacteria (due to Blisters)

I recently got a call related to a blister; a healing blister. But the real reason for the call was to ease worry about possible infection… “I went swimming and I don’t want get that flesh eating bacteria.” So I thought I’d type.

The concern is legit, and we’ve seen plenty of news stories about people needing skin grafts and losing limbs. An ER doc friend of mine had to stop practicing medicine years back because of such an infection. So it’s real. Unfortunately, I think the news doesn’t properly convey the medical buzz words; just the fear.

When it comes to small blisters from dancing in tight shoes vs. life threatening deep tissue infection, here is what drives our decision making:

Red Flags:

• Pain worse than what you’d expect (If a lesion looks minor, but the patient is writhing in agony, then we have a much closer look.)
• Fevers
• Red streaks
• Pus
• Multiple weeping blisters
• Rapid progression
• Extension over joints
• Multiple sites of infection
• Altered thinking
• Unconscious (naturally)
• Frail, elderly, kids
• IV drug use
• Recent surgery
• Chronic illness (diabetes, renal failure, liver failure, etc)
• Immunosuppressed (HIV, steroid use, cancer, organ transplants, etc)
• Past history of necrotizing fasciitis

Happy Words

• Localized to one spot
• Lesion unchanged for multiple days… and not dead yet
• “It itches more than it hurts.”
• “I’ve had this before and it got better on its own.”
• “My flipflop was rubbing, and that blister bothered me in the pool. I just want do be sure it’s not that flesh eating infection.”
• “I popped the blister yesterday and it feels better already.”
• “I think it’s fine, but my wife told me to come get it checked.”

I group terrible medical problems into those that explode and those that ramp up. For you math brains, explosions are step functions. Some aneurysms, strokes and pulmonary emboli fall into this category. Things that ramp up get worse exponentially. Infections like appendicitis, meningitis, cholecystitis and necrotizing fasciitis (flesh eating bacteria) fit here. Every bad infection starts off as a not so bad infection. So the question for patients is where/when on the curve is it time to seek help. And the question for doctors is when to go nuts with testing and treatments.
One hard part about emergency medicine is that we have limited access to those illness progression curves. We have a brief moment in time to make decisions. Of course, we can hang onto patients for hours to watch their illnesses progress, but that generally gums up the conveyor belt. So if there is any concern for serious infection, we go deep and fast. IV fluids, blood counts, blood cultures, wound cultures, lactic acid levels, X-rays, antibiotics ASAP…
The broader topic is called “sepsis,” and today our care for sepsis is being highly scrutinized. So if you arrive with an elevated heart rate and fever, you just might be launched down this path. Maybe we’re saving more lives with our rigorous protocols, but we’re certainly amplifying the bills.

In any case, one reason that I like Pre-R is because I have more time to assess “slopes.” That’s another way of saying that I like follow up over days, and being able to work with patients to see if their problems are getting better or worse, quickly or slowly.

And that blister… It healed just fine.

Was the info helpful?

We strive to provide ad-free quality content. Help us to keep going!

Like what you read? Please share.

Menu