When the red welts began to appear on her son's backside around Thanksgiving, Tracey Carino was concerned. By Christmas Eve, they had become open, weeping sores that had to be drained. They came back again around Valentine's Day, prompting another trip to Medical College of Georgia Children's Medical Center.

"We just didn't know anything about it," Mrs. Carino said inside an isolation room while, elsewhere, pediatric surgeon Charles Howell was draining her son's abscess of pus. "We didn't even know it was this big a problem."

While some worry about a bird flu pandemic, the country is already awash in antibiotic-resistant germs like the one that is continually infecting the 7-year-old North Augusta boy. Once an exotic complication for very sick hospital patients, methicillin-resistant staphylococcus aureus, known as MRSA, is routinely showing up in the community, particularly as skin infections in children.

"At least half and perhaps more than half of community-acquired skin infections from staphylococcus are now (community-acquired) CA-MRSA," said J. Peter Rissing, the medical director for MCG Hospital and Clinics and an infectious disease specialist.

About two years ago, e-mail lists for infectious disease doctors began filling up with comments about drug-resistant skin infections appearing on children in the emergency room, said Jim Wilde, the medical director of the Emergency Department at the Children's Medical Center.

"About the time that buzz started, it exploded in Augusta," he said. "And since then, it's becoming an epidemic. We probably drain a dozen abscesses due to (this bacteria) in our ER every week, and maybe more. We get a lot of them."

The history of antibiotic resistant bacteria is as old as antibiotics - within a year or two of penicillin appearing in the 1940s, there were bacteria resistant to it. It became such a problem that in the 1950s, "people were dying from staph infections that in the early '40s they had been able to cure," Dr. Wilde said.

Then methicillin, a semi-synthetic form of penicillin, appeared in 1961, followed by a long line of other variations and classes of antibiotics. But in the mid-'80s, the methicillin-resistant staph bacteria became a complication for hospitalized patients, Dr. Rissing said. When it showed up in the community, it appeared to be a different strain than the hospital one, Dr. Rissing said.

"What's quite striking about the staph aureus in the community is this organism seems to have additional factors favoring infectivity," Dr. Rissing said. The bacteria have a genetic element that makes them more invasive, particularly in the skin, but that can make them more dangerous to other organs, Dr. Wilde said.

"With (this bacteria), if it gets into your lungs, you're looking at an infection that causes a necrotizing pneumonia. It's causing the tissue basically to be chewed up by the bacteria, and it's forming abscesses in the lungs," he said. "It's a nasty bug ... if it gets in your lungs, if it causes meningitis, if it causes a bone infection or a bloodstream infection."

But it can easily be missed when the patient shows up for treatment, Dr. Wilde said.

"A lot of folks are mistaking these for spider bites," he said.

"It can do a lot of other things, but it's right striking how many of these people present with a history that they had a little red spot, and now they have an abscess where they used to have this red spot," Dr. Rissing said.

Even when patients do receive the right treatment, such as another antibiotic called vancomycin, it can create its own problems, Dr. Rissing said. The antibiotic can affect the bacteria in the digestive tract, he said.

"And what's actually happening in this ecosystem, because that's what it is, the 'good bacteria' hold in check and compete with the 'bad bacteria.' And what you do with an antibiotic in some patients is you knock out the good bacteria and the bad bacteria overgrows," Dr. Rissing said.

This has helped the rise of another antibiotic-resistant bug known as vancomycin-resistant enterococcus. Back in the early 1990s, only 1 percent of those bacteria were resistant; now, 40 percent are, Dr. Wilde said.

Overuse of other antibiotics is also fueling the rise of a noxious bacteria in the digestive tract known as clostridium difficile, which produces a harmful toxin.

"Then what happens is your colon is exposed to a toxin. And it's like it got burned from the inside," Dr. Rissing said.

The development of resistance by bacteria is inevitable, Dr. Wilde said, but what has doctors concerned is the development of antibiotics hasn't kept pace. They're afraid they could see a "post-antibiotic era" where the drugs are no longer effective against common bacteria, he said.

"The way to look at this is the bugs have us outnumbered," Dr. Wilde said. "And no matter what we do, there will always be more bacteria taking the place of the ones we kill. We cannot beat the bugs. What we can do is to try to use the weapons we have against the bugs wisely. And to push off that date at which those antibiotics are not effective. And hope that in the meantime, we can develop new antibiotics."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.