Ellen Lamel, M.D.
The superbugs are here, and your child may be at risk.
Widespread and inappropriate antibiotic use have encouraged the emergence of a "superbug" version of the familiar "Staph," short for Staphylococcus aureus. Staph is a familiar source of infection, and many children carry the bacteria without symptoms, have mild skin infections such as impetigo, or infected hair follicles (folliculitis). It also causes wound infections, boils (abscesses), and skin infections that involve a larger area and all layers of the skin (cellulitis).
The superbug version of Staph is called MRSA - Methicillin Resistant Staph Aureus. It has become resistant to most antibiotics, causing devastating infections in hospitals and nursing homes for years. This type of Staph typically infects older adults or those with depressed immunity and serious chronic illnesses.
A new strain of MRSA has appeared and is increasingly common as a cause of infection in healthy people, many of them children. Called "community-acquired MRSA," it has surfaced where "the four Cs" occur:
• Crowding
• Skin contact
• Contaminated surfaces
• Insufficient cleanliness
Experts have cited school athletic teams and daycare centers as sources in recent outbreaks.
Most community-acquired MRSA infections are skin infections, resulting in abscesses or cellulitis. Occasionally, community-acquired MRSA will cause other infections, such as pneumonia. In the 2003-2004 flu season, an unusual number of previously healthy children died of influenza and its complications. In some of these children the complication was community-acquired MRSA pneumonia.
Staph infections, including MRSA, do not spread through the air by sneezing or coughing. Rather, they spread by direct contact with an infected person or object, such as using the same gym equipment, handling dirty wound dressings, or touching pus or other liquid from an open wound.
Community-acquired MRSA skin infections may look no different than non-MRSA skin infections - in either case the skin will be red, hot, painful, and swollen. If pus or drainage is present, your doctor can diagnose MRSA with a culture. When there is no drainage or pus, diagnosis is more difficult. Fluid withdrawn by syringe from the area that appears most red and firm may help, but is much less successful at finding the bacteria at fault. If your child has been taking antibiotics for 48 to 72 hours and the infection is worse or hasn't improved, check back with your doctor - a change of antibiotics is in order.
Community-acquired MRSA is easier to treat than the hospital variety. Any abscess must be drained - antibiotics alone will not cure an abscess, although drainage alone may. Cellulitis, a deeper skin infection that doesn't produce pus, requires antibiotics.
The hospital version of MRSA usually responds only to vancomycin, given intravenously. The good news about the community-acquired strain is that while resistant to the usual anti-Staph drugs like cephalexin (Keflex) or dicloxacillin (Dynapen, Diclox), it can be cured by some common, older antibiotics. Sulfa drugs such as Bactrim, Sulfatrim, or TMP/SMX are successful, as is tetracycline. Two less commonly used drugs, rifampin and clindamycin, can also be effective against this type of MRSA. Occasionally community-acquired MRSA causes severe, even life-threatening, infections requiring hospitalization. In those cases, doctors will give intravenous antibiotics, either vancomycin, or a newer drug (linezolid, quinupristin-dalfopristin, or daptomycin).
Prevention of MRSA means cleanliness over and above that used in normal circumstances. If someone in the house has a skin infection or boil, everyone in the household should:
• Wash hands meticulously after touching dressings, soiled clothing, or any item that may have touched the infected part. Always wash after skin-to-skin contact with the infected area.
• Not share items used for personal hygiene such as washcloths, towels, razors, hair cutting or plucking devices.
• Keep infected areas which drain pus or any liquid covered with dressings, and dispose of soiled dressings immediately.
If someone in the house has MRSA, add these precautions:
• Launder clothing and linens in hot water and use a dryer instead of air-drying.
• Keep infected areas which drain pus or any liquid covered with dressings. Wear disposable gloves to change dressings, and dispose of the gloves and soiled dressings immediately.
• Wash or disinfect any item touched by pus or contaminated dressings. Use hot water for washables.
• Wipe down items such as bed frames or counters if they come in contact with pus, drainage, or contaminated dressings. Use a freshly mixed bleach solution: one tablespoon of bleach in one quart of water. Metal objects such as tweezers can also be washed or soaked in a bleach solution.
Your child's school or athletics program should have a policy for infection control. The University Interscholastic League of Texas suggests these guidelines:
• Don't allow sharing of towels, soap, or grooming aids.
• Have athletes shower as soon as possible after direct-contact sports.
• Clean equipment at least weekly with a solution of one part bleach to one hundred parts water (one tablespoon of bleach in one quart of water).
• Wash soiled uniforms in hot water and dry them on the hottest cycle. If they are laundered at home, then they should be put in a plastic bag for the trip home.
• Ensure that parents of athletes know to inform the athletic director or trainer if a child has a skin infection diagnosed as MRSA. These students should avoid contact sports until the trainer or a doctor clears the athlete to return.
If your child has an area that is red, swollen and painful, you should see the doctor when:
• It lasts for more than a few days.
• The infected area is spreading.
• A wound appears infected.
• A fever is present.
Community-acquired MRSA can be serious, even life-threatening in rare cases. If your child is diagnosed with abscesss or cellulitis, ask about the possibility of MRSA. As for any other infection, the best defense is prevention, so make hand washing a priority in your home.
Ellen Lamel, MD, is a graduate of University of Colorado School of Medicine and the Los Angeles County/University of Southern Californnia Medical Center Emergency Medicine Residency program. She has practiced emergency medicine for over 20 years.
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