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Most people have heard of the Staphylococcus aureus bacteria. Also called S. aureus or simply 'staph', this bacteria is one of the most common causes of skin infections. Although 'staph' can cause serious infections, like blood and bone infections, pneumonia and surgical wound infections, most infections are minor, such as impetigo, cellulitis and small abscesses or boils.
And unfortunately, more and more people are becoming aware of MRSA, or methicillin-resistant Staphylococcus aureus.
While regular 'staph' infections are usually easily treated with cephalosporin antibiotics that are related to penicillin, like Keflex, Duricef, and Ancef, the MRSA bacteria has developed a resistance to these antibiotics, so that they don't work anymore.
How common are staph and MRSA infections?
It is estimated that 25% to 30% of people have the staph bacteria either on their skin or in their nose, althought it doesn't necessarily cause an infection unless there is a break in the skin, like from an insect bite or scratch. Unless they have an infection, these people are simply 'colonized' with 'staph' and don't necessarily need treatment.
Although usually thought of as a 'nosocomial' infection or one that is spread among people in the hospital or a nursing home, etc., MRSA infections are becoming increasingly more common in healthy people who have not been in the hospital (community acquired infections).
There have also been reports of outbreaks 'among participants in competitive sports,' including fencers, football players and wrestlers. These outbreaks may be because athletes have many risk factors for infection, including 'physical contact, skin damage, and sharing of equipment or clothing.'
How did 'staph' become resistant to antibiotics?
Probably because of the general overuse of antibiotics these days. When you take an antibiotic, like Omnicef, Vantin or Ceftin, for an ear or sinus infection, in addition to targeting the bacteria causing those infections, if you are colonized with 'staph', the 'staph' bacteria is also exposed to those antibiotics and so have time to 'learn' how to fight them or become resistant.
Even if your child isn't on antibiotics a lot, if he is in daycare or around a lot of other children who are often on antibiotics, then he might be exposed and can catch resistant bacteria.
Can you treat 'staph' and MRSA infections?
Fortunately, yes. Although MRSA is resistant to methicillin and related penicillin type antibiotics, there are usually other oral antibiotics that still work, like Bactrim (trimethoprim-sulfamethoxazole) and Clindamycin. Vancomycin is usually the drug of choice for hospitalized patients.
Linezolid (Zyvox) is a newer antibiotic recently approved for use in adults, can treat MRSA and VRSA (Vancomycin Resistant Stapylococcus aureus), and which has been found to be 'effective and well-tolerated in children.'1
Also, when possible, these infections often clear up quickly if the wound can be drained.
There have been reports of deaths from MRSA though, including 4 children from Minnesota and North Dakota from 1997-1999, and three recent deaths in Houston.
How do you know if you have MRSA?
If you have a skin infection that isn't responding as it should to usual treatments, then you should suspect that your child has an MRSA infection. Your doctor can then try to do a culture to confirm that it is MRSA and find out what antibiotics the bacteria is susceptible to.
Shouldn't we just skip to using drugs that work against MRSA when your child has a simple skin infection? While that might work in the short term, the worry is that MRSA bacteria will also develop resistance to these antibiotics and then no treatments will work. There are already reports of VRSA or Vancomycin Resistant Stapylococcus aureus.
So no, unless your child has a serious infection or your doctor suspects MRSA for some reason, it is probably still a good idea to start with regular antibiotics that work against typical 'staph' bacteria. If you live in an area where there is a high percentage of MRSA infections, then some experts recommned 'a change in empiric therapy of infections suspected to be caused by S. aureus.'2
Your doctor might also suspect MRSA if your child has any risk factors, such as 'prior hospitalization, surgery or antimicrobials within the last 6 months, day-care center attendance and/or day-care or household contact with health care workers, or those with chronic underlying diseases.'3
Preventing 'staph' and MRSA infections?
As with most things, prevention is important to avoid these infections.
Understanding that 'staph' and MRSA is usually spread from having close contact with infected people can help you avoid these infections. In addition to direct physical contact, it may also be spread by 'indirect contact by touching objects (i.e., towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or staph bacteria.'
To avoid 'staph' and MRSA, the CDC recommends that you and your kids practice good hygiene, including:
- Keeping your hands clean by washing thoroughly with soap and water. Athletes should be encouraged to shower and wash with soap after all practices and competitions.
- Keeping cuts and abrasions clean and covered with a proper dressing (e.g., bandage) until healed.
- Avoiding contact with other people’s wounds or material contaminated from wounds, including towels, clothing and sports equipment.
If a family member is diagnosed with MRSA, it might be helpful to prevent its spread by treating all family members with Bactroban nasal ointment (to prevent colonization) and an antimicrobial wash, like Hibiclens. This 'decolonization' is controversial though and not all experts recommend it because of the concern that it might lead to even more resistance.
Most importantly, to prevent the continued spread of MRSA and other resistant bacteria, don't ask for antibiotics when your child has an infection that doesn't need it, like a cold or the flu. Although in the past, resistance simply meant that you might have to take 2 or 3 antiobitics to clear your child's ear or sinus infection, the consequences are becoming much more serious, as children are dying from these MRSA infections.
For more information:
References:
1Linezolid for the treatment of methicillin-resistant Staphylococcus aureus infections in children. Kaplan SL - Pediatr Infect Dis J - 01-SEP-2003; 22(9 Suppl): S178-85
2Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children.
Sattler CA - Pediatr Infect Dis J - 01-OCT-2002; 21(10): 910-7
3Methicillin-resistant Staphylococcus aureus in the community. Bratcher D - Pediatr Infect Dis J - 01-DEC-2001; 20(12): 1167-8
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