Infections: Methicillin-Resistant Staphylococcus Aureus

 

Transcript:

 

Guest:  Dr. Sandra Fowler – Pediatrics

Host:  Dr. Linda Austin – Psychiatry

 

Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m talking, today, with Dr. Sandra Fowler who is Associate Professor of Pediatrics and an expert in infectious disease.  Dr. Fowler, one of the really hot topics these days that everybody’s very concerned about is the so-called MRSA infection.  Can you explain what that is?

 

Dr. Sandra Fowler:  MRSA stands for Methicillin-Resistant Staphylococcus aureus.   Staphylococcus aureus is a very common bacterium that has, over the years, acquired the additional descriptors of methicillin resistance to reflect that it has acquired genes that render it resistant to the common antibiotics that are usually used to treat it. 

 

Beyond that, there are actually two types of MRSA.  There is a hospital-acquired type, which has been around, probably, for 20 or 30 years, and there is a community-acquired type, which we’ve been seeing in our clinics with a fair amount of regularity for, probably, 3 or 4 years.  It’s just recently hit the media as kind of an explosive new disease, but it’s really been around for a number of years.

 

Dr. Linda Austin:  Any thoughts as to why this should have become a problem a few years ago?

 

Dr. Sandra Fowler:  The resistance pattern of the two MRSAs is different, so where this community-acquired organism came from is not so clear.  It appears to be readily transmitted person to person, probably by skin, hand contact and, sometimes, by the sharing of personal items.  You know, you’ve heard about outbreaks in gyms and among members of professional sports teams.  I wasn’t aware that people share razors and towels in locker rooms but, apparently, they do, and that can certainly foster the transmission of this organism. 

 

What’s unique about the community-acquired MRSA, and that’s the one I think people are focusing on, and the media hasn’t been so clear about distinguishing those, is that it has a real propensity to cause skin infections, skin boils and abscesses, and then, rarely, but, you know, they’re very significant infections, they can cause overwhelming blood stream infections, bone infections, bad pneumonias as well.  But, the most common infections that they cause are skin abscesses.  Sometimes they can be recurrent.  I’ve seen children have multiple recurrences of them.  I’ve seen entire families involved with multiple family members having these skin boils also.

 

Dr. Linda Austin:  How often are these fatal?

 

Dr. Sandra Fowler:  I couldn’t give you an exact number.  These are very uncommonly fatal.  They [fatalities] happen but it’s very uncommon.  The hospital-associated MRSAs are usually associated with adults who are hospitalized who have other things wrong with them.  The fatality rate associated with those is much higher than those associated with the community-acquired form. 

 

Dr. Linda Austin:  How do you go about treating it?

 

Dr. Sandra Fowler:  Well, they’re not so hard to treat.  Most of them will resolve if you can drain the pus, so by going into the doctor or the emergency room and have them lanced, or opened up, and drained.  Or, sometimes, if they’re very small, parents can put warm compresses on the skin lesions and let them draw up to a boil and then drain, and most of the time, they’ll go away on their own. 

 

Sometimes, when the abscesses, are very large, they require antibiotic therapy as well.  While there is drug resistance, and we can’t use some of the antibiotics we used to use, there are a couple of antibiotics that can be taken by mouth that are effective in treating the community-acquired MRSA.

 

Dr. Linda Austin:  I would imagine, though, that you would be very reluctant to recommend a parent do that because they might, then, get the infection themselves, mightn’t they?

 

Dr. Sandra Fowler:  They’ve been living in the home.  They, probably, have shared this organism.  You bring up an important point though.  While we know a lot about these infections, and we can treat them effectively, we don’t understand a lot about where the bacteria lives and how we can get rid of it.  I think it has a propensity to live on the skin.  It can be very difficult to eradicate it from the skin and that’s why we see people having the recurrent abscesses and boils on the skin.  So, it’s very important for anyone who has a lesion or is exposed to someone who has a lesion to practice really good hand hygiene with soap and water or the alcohol-based hand sanitizers and to make sure that they don’t share personal items.  Every family member should have their own towel, razor, etc.

 

Dr. Linda Austin:  That’s probably good hygiene anyway, right?

 

Dr. Sandra Fowler:  It is.

 

Dr. Linda Austin:  You don’t know who might be harboring a bacterium like that.  People get little boils and abscesses, and pimples, on their body all the time and you’d have no way of knowing if it happened to be MRSA or not, unless that person went into the emergency room.

 

Dr. Sandra Fowler:  Right.  What we also know is that most of the children who come into the Children’s Hospital emergency room, who have the boils and abscesses, 80 percent of them, at least 80 percent of them, are due to MRSA. 

 

Dr. Linda Austin:  That’s quite a large number.

 

Dr. Sandra Fowler:  It’s a lot.  Over the past five years or so, it really has mushroomed.

 

Dr. Linda Austin:  So then, what advice would you give to a parent who notices that their child has an abscess or a boil, or a large pimple?  Are there guidelines for when that should get medical care?

 

Dr. Sandra Fowler:  Well, if it’s the size of a pimple, something that’s very small, up to a half an inch or so, you might try to put warm compresses on it to get it to drain.  If it’s very painful, if it’s large or if the child seems sick in any way, with fever or not acting normally, then they need to be seen by their primary care provider or go to the emergency room to have that evaluated.

 

Dr. Linda Austin:  Certainly, many folks who are listening to this might be concerned, then, about themselves or a child sharing school equipment or sitting on benches in locker rooms, or that sort of thing.  How concerned should a parent be?

 

Dr. Sandra Fowler:  We do know that Staph is capable of living on environmental surfaces for some limited period of time.  But, most of the outbreaks occur in settings where there is a lot of sharing of personal items.  You couldn’t just attribute it to having touched a locker or a bench.  People sharing towels, razors, having close contact of athletic equipment, like football pads, other things that people might share, where there’s abraded skin as well, are much more important ways to transmit it, as opposed to casual contact with a surface.

 

Dr. Linda Austin:  Any precautions in particular that parents or kids should take to avoid getting this?

 

Dr. Sandra Fowler:  Well, I think the most important thing is good hand hygiene.  For young children, I recommend that parents keep their fingernails short so that when they scratch and put their hands to places, they’re not abrading the skin and, thus, not allowing a way for the bacteria to get into the skin.  Then I recommend liberal use of the alcohol-based hand sanitizers.  They’re very easy to use.  They don’t dry the hands, and they’re very effective. 

 

Besides the hands, this organism probably lives other places on the skin and we don’t know how to eradicate it from those other sites.  There are people who’ve recommended using antibacterial soaps and, you know, even more aggressive soap regimens, such as the chlorhexidine soaps that are used in hospitals, but we have no evidence that those work.  There are others that use intranasal antibiotics, that is, antibiotics applied inside the nose, because this bacteria is carried in the nose.  But, I don’t think, and no evidence shows, that eradicating it from the nose has any impact on development of disease.

 

Dr. Linda Austin:  Dr. Fowler, thank you so much.

 

Dr. Sandra Fowler:  You’re welcome.

 

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