In the past several years, doctors have seen a tremendous increase in the number of cases of MRSA (methicillin-resistant staphylococcus aureus) infections. Historically, MRSA was a type of “staph” infection found only in hospitals or other health care settings (e.g. nursing homes). Healthcare-associated MRSA (HA-MRSA) was and still is a very serious infection. This strain of bacteria is often multi-drug resistant, and doctors treating these patients often have difficulty finding antibiotics that will work to kill this infection. This nasty bug has been known to infect multiple areas of the body including skin, urinary tract, lungs, and bloodstream, sometimes with a fatal result. It has the capacity to form a biofilm on hospital equipment such as catheters and breathing tubes. It can survive on surfaces in patients’ rooms, stethoscopes, blood pressure cuffs, and most importantly hospital workers’ hands. Some health care workers and patients are even unknowingly colonized with this bacteria. When a person is “colonized” that means they carry the bacteria (often in their noses), but do not exhibit signs of infection. Colonized people can still transmit the infection. Hospitals have been aggressively battling this microscopic tyrant for years, and have recently stepped up efforts to prevent transmission because of the worsening threat it has become.
In the early 1990s, this bacteria began finding it’s way into the community and infecting people (usually on the skin) who had not been hospitalized. Today this is such a common infection, I consider it any time I see a patient with a skin sore. A few years ago, I saw a flurry of petrified patients in my office after the media pushed the panic button on MRSA and led us to believe that a killer bacteria was invading our communities. Some people had no symptoms but wanted to be treated because they thought somebody they knew had it (bad idea for many reasons, but that’s another blog). People should have an educated concern about MRSA, but not irrational fear. This education should start with an understanding of the difference between HA-MRSA and the community-associated MRSA (CA-MRSA) strain that is not nearly as deadly. So what is the difference? How can people protect themselves?
CA-MRSA usually manifests itself as a skin infection, and is often found in children and adolescents. Outbreaks on sports teams have occurred. Patients will often mistake it for a “spider bite” because they have a single raised red bump that has a pustule in the center. The area will often progress to a larger, tender area and can have a cluster of pimples or a larger area that drains pus. It may even become ulcerated. CA-MRSA is resistant to many antibiotics, but thankfully it typically is not resistant to as many as HA-MRSA. CA-MRSA infections are usually sensitive to common antibiotics like trimethoprim-sulfamethoxazole (Bactrim), clindamycin, and/or doxycycline. Also, it is unusual for a healthy person to develop a CA-MRSA skin infection that invades other areas of the body (bloodstream, lungs, etc.). Any person with a compromised immune system (diabetes, HIV, on medication that suppresses immunity, etc.) will be higher risk for invasive infection, but these skin infections can usually be eradicated with antibiotics and/or drainage of the infected pus. Doctors have been relieved that most CA-MRSA infections are seen in young, healthy people and respond well to treatment.
Having a compromised immune system is always a risk factor for infection. Other risk factors that are specific to CA-MRSA include:
1) Skin trauma (abrasions, cuts, sores)
2) Being an athlete (particularly a wrestler or lineman on a football team)
3) Being overweight or obese
4) Body shaving
5) Physical contact with a person who has a draining skin lesion
6) Sharing personal items/equipment that are not cleaned between users (towels, gym equipment, razors, cosmetics, brushes, clothing, etc.)
So what is the best way to protect you and your family members from this infection? Following the guidelines below will not only help to prevent CA-MRSA, but a multitude of other infections as well:
1) Avoid contact with anyone who has a draining skin lesion
2) Avoid sharing personal items
3) Clean gym equipment before and after use
4) Wash your hands frequently and carry hand sanitizer with you for occasions when washing is not convenient
5) Seek medical attention immediately if you develop signs of a skin infection
6) If a household contact is diagnosed with CA-MRSA, be sure s/he keeps the area fully covered. Wash all clothing and linens and disinfect areas of frequent contact (doorknobs, faucets, etc.)
So, what is MRSA? The answer is both a killer bacteria and a treatable skin infection. Thankfully, most of us will never have to deal with the former, and we shouldn’t panic about the latter. A little common sense helps in preventing CA-MRSA, and seeking medical care early when a suspicious skin sore develops will usually result in a cure without any serious complications.
Shari S. Phillips, M.D.
Your Lake Norman Physician