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Staph infections! Myths, facts, prevention and treatment

By Dr. Moghissi - December 2007

Methacillin resistant Staphylococcus aureas (MRSA) has caused quite a stir recently.  On Oct 15th 2007, an otherwise healthy teenager in Bedford County (central Virginia, near Lynchburg) died of complications from MRSA, and 2 days later JAMA (Journal of the American Medical Association) published an article citing a huge increase in the number of infections in recent years.  More reports surfaced; several cases were reported in the metropolitan DC area, including several in local schools.  School districts had massive cleaning operations, some closing down briefly.  What’s really going on here? 

Staph aureaus is a bacteria that is found in the environment, and likes to live in human noses.  Official statistics say that 20-30% of people will grow out staph aureaus if you culture their noses, but informal studies have shown that if the investigator is aggressive, over 90% of people will grow out staph aureaus.  Those people are considered colonized, meaning that the bacteria live there, but does not make them sick.  When a colonized person scratches their nose, the bacteria get on the fingers and under the fingernails.  If they then scratch other parts of their body, and the skin has a break in it, the bacteria can enter and cause an infection.  This scratching often happens during sleep, and people typically will scratch the face and thighs.  Kids are especially prone to this.

What is MRSA?

When Penicillin was discovered, it would cure staph infections.  Over time, some of the bacteria were able to develop defense mechanisms against penicillin, making some infections harder to cure.   More antibiotics were developed to treat resistant infections.  Methacillin (a beta lactam antibiotic) was introduced in 1959 to treat penicillin resistant staph aureaus.  A year later there were already strains resistant to the methacillin.  These strains were named methacillin resistant, hence MRSA.  At first MRSA was only found in hospitals or other health care settings, because that’s where the most antibiotics were used.  In the past 20 years though, the resistant strains have become more common in people who have not been in the hospital, (community acquired) and they have become resistant to a wider variety of antibiotics.  Today it is thought that more than 50% of staph aureaus infections are methacillin resistant.

Unfortunately, not only are there fewer antibiotics available to treat MRSA, but it is also more aggressive.  MRSA has developed a special gene that allows it to resist many antibiotics, and this same gene produces a toxin that is actually increased with use of beta lactam antibiotics.  This means that not only is an infection with MRSA more serious and progresses more quickly than regular (non-resistant) staph, but treating it with beta lactam antitiobics can cause the infection to become even more dangerous.

Since 90% of people are colonized with staph, and many (most?) of those probably have MRSA, why aren’t we all dead? 

Healthy people with intact immune systems rarely get systemic (in the blood stream) infections.  Our bodies are constantly successfully fighting off bacteria and viruses.  Most people who die of MRSA have other medical issues that compromise their immune systems.  For example, they may have cancer, be very old, or have illnesses like AIDs.  Rarely, an otherwise healthy person may get sick, which is apparently what happened to that teenager.  We really don’t know why some people get very sick, and others are fine.  That’s what makes this so scary.

What does MRSA infection look like?

MRSA most commonly will look like impetigo; that is a pimple or boil often on a red warm base.  It will often have pus, may drain and be red, swollen and painful.  More serious infections will be internal, and the person will be very sick.  Here is a picture of a typical MRSA skin infection.

Picture of a MRSA boil

So what can I do to protect myself and my family?

The most important thing is to wash your hands frequently with soap and warm water.  Alcohol-based hand sanitizers will protect also, but be careful using these around children, as they have a very high alcohol content.  If you have any open wounds, make sure you keep them covered.  Not only does that help protect you from infection, but it also protects others from potential infections you might have.  Finally, don’t share personal items such as razors, towels, or any items of clothing that may have come into contact with an infected wound.  To properly clean linens, wash with water and laundry detergent, and dry in a hot dryer. 

BTW – these recommendations are just good sense, and are good precautions to use to prevent most any type of infection.

If you think you may have MRSA –

See your doctor!  Your doctor will most likely take a culture of the wound; that is the only way to diagnose MRSA.  If you are given an antibiotic, finish it; do not take a few days and save the rest for next time.  MRSA evolved because staph aureaus was protecting itself from antibiotics (we are, after all, giving antibiotics to kill it).  Do not take antibiotics unless you really need them, and if you do, make sure you take enough to completely kill it.

If you would like to know more, try these links.

http://www.vdh.state.va.us/epidemiology/Surveillance/MRSA/index.htm
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html
http://www.fairfaxcounty.gov/hd/comdis/staph.htm
http://www.health.state.mn.us/divs/idepc/diseases/mrsa/book.html

Jasmine Moghissi, M.D.

Focus - Health Tips » Staph infections! Myths, facts, prevention and treatment

Staph infections! Myths, facts, prevention and treatment

By Dr. Moghissi - December 2007

Methacillin resistant Staphylococcus aureas (MRSA) has caused quite a stir recently.  On Oct 15th 2007, an otherwise healthy teenager in Bedford County (central Virginia, near Lynchburg) died of complications from MRSA, and 2 days later JAMA (Journal of the American Medical Association) published an article citing a huge increase in the number of infections in recent years.  More reports surfaced; several cases were reported in the metropolitan DC area, including several in local schools.  School districts had massive cleaning operations, some closing down briefly.  What’s really going on here? 

Staph aureaus is a bacteria that is found in the environment, and likes to live in human noses.  Official statistics say that 20-30% of people will grow out staph aureaus if you culture their noses, but informal studies have shown that if the investigator is aggressive, over 90% of people will grow out staph aureaus.  Those people are considered colonized, meaning that the bacteria live there, but does not make them sick.  When a colonized person scratches their nose, the bacteria get on the fingers and under the fingernails.  If they then scratch other parts of their body, and the skin has a break in it, the bacteria can enter and cause an infection.  This scratching often happens during sleep, and people typically will scratch the face and thighs.  Kids are especially prone to this.

What is MRSA?

When Penicillin was discovered, it would cure staph infections.  Over time, some of the bacteria were able to develop defense mechanisms against penicillin, making some infections harder to cure.   More antibiotics were developed to treat resistant infections.  Methacillin (a beta lactam antibiotic) was introduced in 1959 to treat penicillin resistant staph aureaus.  A year later there were already strains resistant to the methacillin.  These strains were named methacillin resistant, hence MRSA.  At first MRSA was only found in hospitals or other health care settings, because that’s where the most antibiotics were used.  In the past 20 years though, the resistant strains have become more common in people who have not been in the hospital, (community acquired) and they have become resistant to a wider variety of antibiotics.  Today it is thought that more than 50% of staph aureaus infections are methacillin resistant.

Unfortunately, not only are there fewer antibiotics available to treat MRSA, but it is also more aggressive.  MRSA has developed a special gene that allows it to resist many antibiotics, and this same gene produces a toxin that is actually increased with use of beta lactam antibiotics.  This means that not only is an infection with MRSA more serious and progresses more quickly than regular (non-resistant) staph, but treating it with beta lactam antitiobics can cause the infection to become even more dangerous.

Since 90% of people are colonized with staph, and many (most?) of those probably have MRSA, why aren’t we all dead? 

Healthy people with intact immune systems rarely get systemic (in the blood stream) infections.  Our bodies are constantly successfully fighting off bacteria and viruses.  Most people who die of MRSA have other medical issues that compromise their immune systems.  For example, they may have cancer, be very old, or have illnesses like AIDs.  Rarely, an otherwise healthy person may get sick, which is apparently what happened to that teenager.  We really don’t know why some people get very sick, and others are fine.  That’s what makes this so scary.

What does MRSA infection look like?

MRSA most commonly will look like impetigo; that is a pimple or boil often on a red warm base.  It will often have pus, may drain and be red, swollen and painful.  More serious infections will be internal, and the person will be very sick.  Here is a picture of a typical MRSA skin infection.

Picture of a MRSA boil

So what can I do to protect myself and my family?

The most important thing is to wash your hands frequently with soap and warm water.  Alcohol-based hand sanitizers will protect also, but be careful using these around children, as they have a very high alcohol content.  If you have any open wounds, make sure you keep them covered.  Not only does that help protect you from infection, but it also protects others from potential infections you might have.  Finally, don’t share personal items such as razors, towels, or any items of clothing that may have come into contact with an infected wound.  To properly clean linens, wash with water and laundry detergent, and dry in a hot dryer. 

BTW – these recommendations are just good sense, and are good precautions to use to prevent most any type of infection.

If you think you may have MRSA –

See your doctor!  Your doctor will most likely take a culture of the wound; that is the only way to diagnose MRSA.  If you are given an antibiotic, finish it; do not take a few days and save the rest for next time.  MRSA evolved because staph aureaus was protecting itself from antibiotics (we are, after all, giving antibiotics to kill it).  Do not take antibiotics unless you really need them, and if you do, make sure you take enough to completely kill it.

If you would like to know more, try these links.

http://www.vdh.state.va.us/epidemiology/Surveillance/MRSA/index.htm
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html
http://www.fairfaxcounty.gov/hd/comdis/staph.htm
http://www.health.state.mn.us/divs/idepc/diseases/mrsa/book.html