'The Pitt': What Is Worse Than MRSA? Dr. Langdon's Latest Patient Diagnosis, Explained

The Pitt may have added a bit more levity this week with the return of the emergency room betting pool and a patient whose problems were solved by simply cutting off her eyelashes, but there were still a number of critical patients with unfamiliar diagnoses to muddle through amid the lighter moments.

In particular, one patient returned quickly after being discharged at the start of the July 4th shift with what originally appeared to be a simple rash on her leg.

Debbie Cohen stopped into the ER on her way into her shift at a local restaurant, complaining of pain and redness on the top of her foot.

Doctor Langdon evaluated her in triage, prescribing her an oral antibiotic called Keflex that he believed “should clear everything up.” Still, he drew a line around the borders of the rash with a Sharpie before she left, and advised her to return if her symptoms worsened.

Just a few hours later she returned. In that short time, the pain in her lower leg worsened, and the redness had spread from the top of her foot all the way up her shin, ending just a few inches below her knee. 

Whatever infection she’d acquired wasn’t responding to the original medication, meaning the doctor needed to set her up with an IV to get the antibiotics directly into her bloodstream.

“Is it bad?” Debbie asked, clearly concerned. 

“Not if we can get a handle on it,” Langdon assured her.

However, as he and Donnie stepped away from the patient, the nurse practitioner wondered if they were looking at a case of MRSA, or methicillin-resistant Staphylococcus aureus.

Langdon expressed concern that whatever Debbie had could be “worse” than MRSA, just before the credits rolled, leaving viewers on a cliffhanger until next week.

So, what exactly is MRSA, and, perhaps more importantly, what could be worse?

What Is MRSA?

MRSA is an antibiotic resistant bacterial infection that doesn’t respond well to many typical anti bacterial medications.

According to the Cleveland Clinic, MRSA most often causes infection in the skin, but it can lead to much more serious illnesses that are difficult to treat.

If a person’s infection goes uncontrolled, serious, and possibly fatal, complications include sepsis—a dangerous, systemic overreaction to infection that can lead to organ failure—respiratory failure, or the need for amputation of infected limbs.

How Do You Catch MRSA?

Historically, MRSA was considered a hospital-acquired infection, most often spreading in healthcare facilities, including longterm care facilities and rehabilitation centers. However, since the ’80s, community-acquired infections have been on the rise. These are usually easier to treat than hospital-acquired infections, according to the Cleveland Clinic.

Some individuals have MRSA on their skin or in their respiratory tracts but never get sick themselves because of the bacteria. This is referred to as colonization. But, while a person may not be able to fall ill from the strain they carry, it can still be spread to other people.

MRSA can survive on contaminated surfaces for several weeks, so direct contact with either someone who is infected or colonized or with contaminated objects poses a great risk for infection. Hospital-aquired infections usually come form contaminated medical equipment, like central lines or breathing tubes that haven’t been properly disinfected.

What’s Worse Than MRSA?

Dr. Langdon is most likely concerned that Debbie may actually have necrotizing fasciitis, or the flesh-eating disease.

MRSA and necrotizing fasciitis can share similar symptoms, but the latter is generally considered to be much more dangerous, as it moves quickly and causes a lot of destruction as it goes.

Necrotizing fasciitis can be caused by a number of differenty types of bacteria, including MRSA. The bacteria spreads through the layers of skin known as the fascia, producing toxins that prevent blood from adequately flowing to the tissue and causing the fascia to die, per the Cleveland Clinic. These toxins may eventually spread to a person’s organs, too.

Without adequate blood flow to the affected tissues, a person’s immune system can’t properly react to the invading bactera, and even IV antibiotics are not likely to be enough to prevent further damage. Surgery will be required to stop further spread of infection, and to remove the dead tissue.

Nectrotizing fasciitis is unlikely to spread from person to person, but, like MRSA, can lead to sepsis, organ failure, need for amputation, and, potentially, death.

But, in the preview for the next episode, Dr. Robby appears to diagnose Debbie with severe sepsis, which likely means her organs have begun to be impacted by the infection as a result of low blood pressure. This can ultimately lead to brain damage, heart, kidney, or lung failure, gangrene, or even death.

If this is the case, Debbie’s treatment will likely involve IV antibiotics, IV fluids, medication to raise her blood pressure, and potentially oxygen and even surgery, before being transferred to the ICU, according to the Cleveland Clinic.

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