Ask the Expert: MRSA in children

Staph infections didn't used to cause much of a fuss. They would irritate skin but could easily be treated with antibiotics. Recently, however, antibiotic-resistant strains of bacteria such as MRSA, or methicillin-resistant Staphylococcus aureus, have been surfacing. Dr. Robert Ancona, St. Joseph Medical Center's chief of pediatrics and an infectious disease specialist, have been noticing more concerning MRSA infections in children lately.

What is the difference between MRSA and other bacterial strains?

Staph aureus is a common bacteria with which up to 20 percent of people are colonized. Not everyone colonized gets sick. Traditional staph aureus can cause infections but does not have the same invasive gene as MRSA and responds to traditional antibiotics. MRSA has emerged over the last decade and is a staph aureus bacteria with two changes to its genetic makeup. This altered genetic makeup gives MRSA the enzymes that allow it to invade human tissue more readily and to cause disease more often.

What are symptoms and are they different in children and adults?

The most common manifestations of MRSA are skin and soft-tissue infections: boils and abscesses. They start out looking like a spider bite or a small pimple and grow very rapidly. They get big and tender. The size and pain will bring them to your attention. They can change like this overnight.

The abscesses can occur anywhere on the body, but are more likely to develop in areas of skin breakdown, cuts or openings, such as on the hands, arms, legs, buttocks, and, for females, in the genitalia.

Symptoms are the same in children as in adults, except that children with eczema are more susceptible to MRSA because the rash causes skin breakdown. MRSA infections in children are one of the most common things that doctors and emergency rooms see.

For adults who shave, soft tissue infections can occur in hairy areas, entering through nicks to the skin.

MRSA can also cause pneumonia, deep muscle infections and can occur systemically, though this is not as common. A minor injury such as a muscle strain or a bruise can eventually lead to a MRSA abscess deep in the muscle. If someone has a persistent muscle ache accompanied by fever, they particularly need evaluation. A surface pimple or abscess that becomes larger quickly also needs prompt attention.

What are possible complications, in healthy kids verses those with underlying health conditions?

For both children and adults, bloodstream infections caused by MRSA occur a little more frequently to patients with underlying conditions or who are immuno-compromised, such as those with flu, pneumonia, chicken pox, or who are malnourished. Patients with bloodstream infections are very sick and need hospitalization.

How can the infections be treated if the strain is antibiotic-resistant?

Although MRSA is resistant to many antibiotics, it is sensitive to some antibiotics. There are a handful that can be used intravenously, and a few that can be used orally. The usual antibiotics used to treat staph aureus are not helpful.

The primary treatment is to drain the pus from the abscess or boil, even for the deep infections, which must be done surgically. Patients with MRSA pneumonia have a pus-filled abscess located in the pleural space between the lungs and the chest wall or in the lung itself, which needs to be drained.

Why are more kids picking up infections in the community, and not the hospital?

MRSA has been around for 40 years, and used to be transmitted primarily in hospitals. Thanks to better infection control at hospitals around the country, hospital-acquired MRSA has dropped. However, there is a separate strain of MRSA in the community that has gone up.

Up to 20 percent of children are colonized with MRSA, and up to 2 percent of those colonized are developing MRSA. In some closed situations such as day care, studies have shown there is more colonization. There tends to be a higher colonization rate in day care and schools because children pass things around, and younger children have more intimate contact with each other and poorer hygiene. There's ample opportunity for them to pick it up from each other.

Are there ways to keep kids, and adults, safe from MRSA?

Yes. The primary thing is personal hygiene. The more you wash your hands, the less likely you are to pick it up. Don't share towels and washcloths. Don't touch a wound; wash it with soap and hot water, and keep it covered. Keep breaks in the skin covered with Band-Aids so they don't get infected.

Objects for personal hygiene shouldn't be shared, such as razors. The same is true for athletic equipment. Shower after each sports practice. Soap and water are very effective. If a wound seems not to be healing or you have fever with a lesion, get medical care as soon as you can.



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