When I give talks about methicillin-resistant staphylococci, I almost invariable get into a discussion of the risks of methicillin-resistant S. pseudintermedius (MRSP) in people. This bug is becoming increasingly common in dogs and because it’s so resistant to antibiotics, there’s concern about whether it can be transmitted to people.

My usual answer is that there is a low risk of MRSP infection in people, but not no risk. MRSP is no more likely to cause an infection in a person compared to it’s antibiotic-susceptible counterpart, regular S. pseudintermedius (the resistant version is just harder to treat). Most dogs carry susceptible S. pseudintermedius in their mouths, nose, skin, ears and/or intestinal tracts, so people in contact with dogs are very commonly exposed. Yet, human infections seem to be quite rare. There are periodic reports in the medical literature about S. pseudintermedius infections in people, but they tend to be single case reports, and when someone can publish a report of a single infection in person, you know it’s pretty uncommon (since if it was common, no journal would be interested).

That’s my long-winded way of introducing a recent case report in the Journal of Clinical Microbiology (Hatch et al. 2012). The patient in the report was an elderly man with underlying disease, so someone who was at high risk of infection from bugs that don’t often affect otherwise healthy people. He had skin lesions, sore joints and a bloodstream infection, and "S. intermedius" (I’ll get to the name issue later) was isolated from his blood. Fortunately, he was successfully treated. He owned a dog and that was (reasonably) considered to be the source of the bacterium, but no testing was done to look into that. So, from a disease standpoint, it’s not really a surprising case – just another in a series of very rare infections that have happened.

The other issue here is the fact that the authors (along with the diagnostic lab, the journal’s reviewers and the editor) are behind the times and don’t realize that it’s virtually guaranteed that this person didn’t have a S. intermedius infection. Rather, it was presumably S. pseudintermedius, or perhaps another similar staphylococcus. It wouldn’t have much of an impact on this particular case, although not knowing the species probably also indicates the lab doesn’t know that there are different breakpoints to determine if the bug is methicllin-resistant, and there’s the potential they would miss methcillin-resistant S. pseudintermedius and use an inappropriate and ineffective treatment (fortunately that didn’t happen here).