Saturday, July 14, 2012

MRSA: What You Need to Know

Anna Tielsch Goddard, MSN, CPNP-PC 

What is MRSA?
Many people have heard of “MRSA” from the news or other media sources.  Several years ago, magazines and news-stations began to call drug-resistant bacteria, such as MRSA and VRE (Vancomycin resistant Enterococcus) “superbugs” or “superinfections.” When a child is diagnosed with a MRSA infection, many caregivers and parents may feel panicked, scared, or both.  

The acronym “MRSA” stands for methicillin-resistant Staphylococcus aureus.  Staphylococcus is a type of germ (bacteria) that commonly lives on the skin and is sometimes referred to as “staph.”  These staph bacteria that live on the skin are harmless unless they enter the body through an open cut or wound.  Methicillin is a type of antibiotic that is used to treat Staphylococcus aureus skin infections.  Therefore, a MRSA infection refers to a germ that will not get better with certain antibiotics because the germ is “resistant” to the antibiotic.  

What are Signs of an MRSA Infection?
Signs of staph skin infections are red, swollen, painful boil or abscess on the skin.  It is not uncommon to have pus or drainage from the boil.  Staph infections can start from very minor skin sores such as an insect bite, cuts, scrapes, or pimples.  Many staph infections are very minor and can be treated in your primary care provider’s office.  MRSA infections are most often spread through touching or skin-to-skin contact.   

Is MRSA dangerous?
Many people are carrying MRSA germs on their skin and will never get an infection or any symptoms. This is referred to as “being colonized” with MRSA.  In fact, the Centers for Disease Control and Prevention (the CDC), estimates that approximately 1% of the population are carriers of MRSA.  However, if you are “colonized” with MRSA, you can spread the germ to other people.  

Anyone can get a MRSA infection, even if you are otherwise healthy.  MRSA infections are most commonly found on the skin, especially if someone is “colonized” or have been exposed to MRSA and also have a break or cut in the skin.  

Once a person gets a staph infection, the germ can spread to other organs, joints, or bones.  Some people are at an increased risk of contacting MRSA, particularly if they have a weakened immune system (such as cancer or HIV), recent surgery, or are on kidney dialysis.  MRSA infections can be very self-limiting and treated with antibiotics that are NOT resistant to the staph germ.  Many of these infections are treated on an outpatient-basis (by your regular pediatric primary care provider).  

Some MRSA infections can become very severe and cause more serious symptoms such as: high fever, shortness of breath, headaches, rashes, or a wound that won’t heal.  When the Staph aureus germs spread, they can start to affect the bones, joints, and then enter the bloodstream.  Once the germs are in the blood, they can spread to the heart valves, lungs, and brain.  Surgical wounds are especially susceptible to the spread of MRSA since Staph aureus regularly lives on the skin and the skin is cut open during a surgical procedure.  

How do you treat a MRSA infection?
Your pediatric nurse practitioner or pediatrician will most likely order a culture to diagnose the MRSA infection.  A culture can be taken from the wound itself, from drainage or pus from the wound, or sometimes from nasal secretions inside the nose.  The results from a culture will usually take 1 to 2 days.  

Sometimes your provider will recommend draining the boil or skin abscess, often referred to as an “incision and drainage” or “I&D.”  This should only be done by a health care provider. In some circumstances, your provider will recommend an I&D be performed under sedation or anesthesia.   The nurse practitioner or pediatrician will prescribe an antibiotic for your child based on their individual health history.  If the wound starts to get worse, even after treatment and antibiotics, you should bring your child back to their health care provider.  

Make sure that your child continues to take the prescribed antibiotic as prescribed.  Even though the skin or infection looks healed, antibiotics need to be used for the entire recommended dosage (which can be anywhere from a few days up to 2 weeks). 

Most “super infections” have started because of the overuse and misuse of antibiotics in our culture.  In the past, health care providers prescribed antibiotics for the common cold, flu, and viral infections that we know now will not respond to these drugs.  Furthermore, just as human beings have changed and adapted over the years, germs have also adapted and became resistant to antibiotics.  These germs have built “resistance” to certain antibiotics and now we have “super-bugs,” such as MRSA, which are harder to treat and can cause more severe skin infections.  

How do I prevent the spread of MRSA?
The most important way to prevent a staph infection is to wash your hands.  Children will sometimes need hand-washing to be supervised.  You can teach your child to wash their hands by singing the “happy birthday song” or the “ABCs” while they are rubbing their hands with soap and water.  When you are at the hospital or a physician’s office, make sure that all health care workers or hospital employees wash their hands before they touch your child.  You can also carry a bottle of hand sanitizer when you or your child do not have access to soap and water. 

If your child has a wound, make sure to keep it clean and covered with a bandage or 4X4 gauze until the wound is healed.  Pus or drainage from the wound can spread MRSA.
Avoid sharing personal items. If you have a teenage son or daughter, instruct them not to share towels with one another and always wipe down shared athletic gear.  

References and resources: 

U.S. National Library of Medicine.  Methicillin-resistant Staphylococcus aureus; Hospital-acquired MRSA (HA-MRSA).,  

Centers for Disease Control and Prevention.  Methicillin-resistant Staphylococcus aureus (MRSA) infections., 

Mayo Clinic. MRSA infection., 

American Academy of Pediatrics (2006). Staphylococcal infections. In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 598–610. Elk Grove Village, IL: American Academy of Pediatrics.

About the Author:
Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy.  She practices on the Perioperative Surgery teams in presurgical assessment. Mrs. Goddard is currently working on her PhD at Vanderbilt University School of Nursing. 

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