Winter/Spring 2008

In 1997, the deaths of four children in Minnesota and North Dakota were linked to a rare germ, a germ that was resistant to common medications used to treat it. Although scientists already knew about these so-called “superbugs,” it was their entry into the general population that caught their attention.

Scientists call this germ CA-MRSA. It stands for “community acquired—methicillin-resistant staphlococcus aureus.” It is a common germ that is found on most people’s skin that has gradually become resistant to antibiotics. Its more dangerous cousin is healthcare-acquired MRSA (HA-MRSA) which is much more resistant to treatment.

Since 1997, CA-MRSA has become the most common cause of emergency room visits
for skin and soft tissue infections. Staphylococcus bacteria have long been a cause for both minor infections, such as impetigo, and serious infections, such as pneumonia and blood infections. Staphylococcus aureus is a bacterium that is found throughout our environment. It is hardy, able to survive for relatively long periods in conditions of high heat, drying and low oxygen. Staph can be spread by skin-to-skin contact or via contaminated surfaces. It is found on the skin and in the nose of 30 to 50 percent of healthy children and adults often causing no symptoms or problems (colonization).

When a person is colonized, however, they can spread the bacteria to other individuals and, given the right circumstances, they can develop infections. Some strains of bacteria can become resistant to certain antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) got its name by becoming resistant to methicillin and other antibiotics, (penicillin, oxacillin and amoxicillin). Increasing rates of colonization with MRSA have led to higher rates of infection, first in hospitals and now in the community.

When MRSA infection occurs outside a healthcare environment, it is classified as community-associated MRSA. Certain people within this healthy population are at greater risk for developing CA-MRSA infections. Outbreaks are more likely to occur among children in child-care centers, competitive sports team members, postpartum women and newborns as well as premature infants in the neonatal intensive care unit.

Children under the age of two are at especially high risk as are children with chronic skin conditions such as eczema. The majority of these infections involve the skin and soft tissue, but more serious infections, such as pneumonia and infections of the blood, bones and joints, do occur.

In your child, CA-MRSA skin infections appear as boils, pustules, styes, "spider bites" or abscesses. Areas of the skin may be red, swollen, warm and tender and often have
pus or other drainage. Infections usually start where skin has been cut or scratched or in
areas where there is hair growth. The initial skin trauma may have been so minor as to have gone unnoticed. When deeper tissue infection occurs a child may have fever and feel generally unwell. CA-MRSA may be suspected if there is a prior history of boils or draining skin sores in your child, other family members or classmates as once a person is colonized, recurrent infection is common.

If a staph or MRSA infection is suspected it should be evaluated by a healthcare provider. Most minor infections will resolve with drainage and a short course of antibiotics. Drainage of pus-filled lesions is important. Drainage alone may be adequate treatment and, if done properly, provides a specimen to culture. This laboratory testing is the only way to determine if the infecting bacteria are staph and if it is a sensitive strain or MRSA.

Treatment with an oral antibiotic is usually indicated. There are several that are still effective against CA-MRSA. While sores may improve rapidly, all doses of the prescribed antibiotic should be taken. In children under the age of two years, followup is recommended to ensure resolution or assess the need for further treatment. Sometimes infections may be serious enough to require hospitalization for surgical drainage and intravenous antibiotics.

CA-MRSA infections, whether mild or severe, can almost always be effectively treated. However, once a person is colonized with CA-MRSA, it is very difficult to eradicate the bacteria from all body surfaces. For this reason, CA-MRSA infections have a tendency to recur. Good hygiene practices can help to reduce recurrence as well as transmission:

• Frequent hand washing, especially after touching the nose
• Daily bathing and showering after exercise or sports activity
• Completely covering all open or draining sores
• Not sharing personal items such as towels, razors and sports equipment\

Certain environments are more conducive to transmission as well. Places where there is crowding, frequent skin-to-skin contact, contaminated objects or surfaces and general lack of cleanliness contribute to the spread of CA-MRSA. When CA-MRSA infections occur in schools, child-care centers or sports teams it is generally not necessary to exclude infected individuals or close the institution. Education and renewed efforts to improve hygiene and cleanliness are important. In the event of an outbreak in these settings, public health authorities should be consulted as to the appropriate measures to be taken.

Increasing rates of CA-MRSA disease over the last ten years have lead to greater awareness in the community of this bacterium and the problems it can cause. Continued education regarding the importance of hygiene, appropriate antibiotic use as well as prompt diagnosis and treatment will help to curb this growing epidemic.