Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Comprehensive blend of general pediatric and sport medicine care with an individualized approach that enhances the health and knowledge of patients and their families



Proud physician:
USA Volleyball Mens/Womens National Teams
CS Fullerton Intercollegiate Athletics
Chapman University Dance Department
Orange Lutheran High School

Co-Author of Acclaimed Textbook

Pediatric Sports Medicine: Essentials for Office Evaluation

Orange County Physician Of Excellence, 2015 and 2016


Athletes: Beware of "Spider Bites"

On a fairly frequent basis, I will see an athlete who says “I think I have a spider bite” and greets me with something like this raised “angry” appearing area with a raised central yellow component surrounded by a red, tense outer rim.

Image from:

Image from:

Immediately, I’m thinking of something far different than a spider bite.

In the athletic or performing arts worlds, when something looks like a spider bite, a first thought should actually be a potentially devestating infection known as Methicillin-Resistant Staph Aureus or MRSA for short.

Not trying to minimize being afraid of spiders and the potentially harmful impact of their bites, but overall, MRSA infections have become much, much more common and just as frightening.

We all have bacteria that grow on our skin, and most of them are fairly decent organisms that do little to interrupt daily activities.

However, certain bacteria that live on the skin surface are more ruthless and overtime have gained an ability to cause deeper infections by developing resistance to many antibiotics and thus not always responding to usual medical treatments.

MRSA infections are just those type of worrisome beasts.

And yes, they look “just like spider bites.”

Often starting with something as simple as a small scratch or other break in the skin, if left unchecked, MRSA infections can explode into limb-threatening and even life-threatening conditions that can be readily spread to other teammates and opponents.

Caught early in the course, ultimately less chance for more complicated outcomes.

Contact and collision activities (such as wrestling or football) tend to have higher outbreak rates, but any exposed skin can be at risk.

Some individuals or even families, for reasons not fully understood, are at risk for recurrent MRSA infections.

There is no doubt, however, that prevention is key:

  • Frequent self skin checks looking for open wounds, raised “angry”  areas, or other abnormal skin conditions that should receive immediate medical attention
  • Removal of any individual with skin problems (especially “spider bites”) from group activities and not allowing return until appropriate medical treatment and clearance
  • Wearing of protective devices such as gloves and eye/mouth shields when examiningor treating potential or known MRSA infection
  • Removing exercise gear and clothing right after exercise followed by an immediate shower
  • Daily washing of exercise clothing in hot water and/or using a new, clean set of clothing for each practice or game
  • Studies have shown that sharing of items can increase spreading MRSA or other skin infections
    • Require individual towels, washclothes, hairbrushes, nail clippers, soaps, deoderants and other personal grooming products without sharing any of the above items
    • Concern over possible spread from weight room, athletic training room, or activity related playing surfaces, equipment, tables and/ or benches emphasizes the importance of individualized towels and frequent cleaning with appropriate anti-bacterial products

When I see suspicious wound, if at all possible, I try to open it up to release that yellow “pus” material.

Called “incision and drainage”, this otherwise gross procedure actually serves two very important purposes:

  • The mere act of opening the wound and allowing drainage can get rid of the infection
  • The drained fluid can be sent for lab culture to truly identify the offending bacteria and what best choice of antibiotic(s) may be used if needed in treatment

We think that relative overuse of antibiotics in the past helped create these more resistant bacteria, so in certain cases, depending the drainage alone (without antibiotic use) is a sensible treatment option.

In other cases, such as deeper infections (into muscles, joints, or bones) or where drainage is either unable to be done or appears to be ineffective, antibiotics may be prescribed.

If antibiotics are used, sometimes combinations are selected due to culture/sensitivity patterns and also past trends in the local community.

Oral antibiotics are generally first-line for more skin-surface infections, while deeper or more complicated infections might require hospitalization for intra-venous antibiotics or more aggressive surgical care.

Once treatment for MRSA infection has been started, the following minimal conditions must be met before return to any type of activities with contact or collision with others

  • Any drainage must have ended for at least 24-48 hours
  • No new outbreaks or areas of infection
  • If antibiotics started, must have minimum of 72 hour coverage
  • Infected area must be able to be covered with appropriate “occlusive”dressings that reduce risk of spread

When ANY suspicion of MRSA infection is raised, immediate medical attention is absolutely essential.

So, be appropriately afraid of those "spider bites".....