MRSA: The persistent staph

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The Pediatric Insider

© 2011 Roy Benaroch, MD

An anonymous visitor posted, “My son has had recurrent staph infections in his skin with MRSA. He gets boils and impetigo. We keep giving antibiotics, and they keep coming back. Is there any way to get rid of staph for good?”

Staph has become a very tricky bacteria—it’s become more invasive and destructive, and resistant to many common antibiotics. It also seems to be able to hide away and recur in many people. Over just the past few years of practice, our approach to staph has changed, and we still have more to learn about the best way to handle it.

By staph, you probably mean the bacteria formally called Staphlococcus aureus. The new variety that’s causing a lot of mischief is abbreviated “MRSA”, short for methicillin-resistent Staph aureus, sometimes pronounced “mer-sa.” The typical MRSA variety found in communities is resistant to many antibiotics, but certainly not all of them. An even nastier, hospital-based “super-MRSA” has become resistant to almost all antibiotics.

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MRSA infections are usually found in the skin, either causing a deep abscess or boil, or an infection just atop the skin called “impetigo.” Deep infections are tender and warm, and have a raised, tense feeling. Impetigo looks like areas of broken skin with honey-colored pus. Sometimes these infections can occur together. Staph skin infections are often mis-labeled “spider bites.” More serious, invasive infections with MRSA can include bone or joint infections, pneumonia, or abscesses in deep organs.

Treatment begins with getting rid of the pus. Impetigo should be thoroughly washed at least once a day (ordinary soap is fine, with plenty of running water.) Deep abscesses will usually have to be drained, with may require a cut through the skin. After drainage, sometimes a small wick of fabric or a small length of hollow tube is left in place to prevent pus from re-accumulating.

A well-drained abscess may mot need any antibiotics, but other kinds of infection do. Antibiotics that are reliably effective against ordinary community MRSA include Bactrim and clindamycin, or doxycycline (for older kids only.) Between drainage, cleaning, and antibiotics, an acute MRSA infection can usually be knocked out.

Often, MRSA infections recur. Antibiotics treat the acute infection, but don’t do a great job getting rid of the bacteria for good. Staph likes to hide in body crevices and orifices (so nose-picking and butt-scratching should be discouraged, though stopping those habits entirely may be impossible.) Strategies to eliminate staph carriage can include using topical antibiotics in the nose (staph likes to hide there), soaking in a diluted bleach solution, using special medicated soaps, decontaminating bedsheets, or treating asymptomatic family contacts with topical or oral antibiotics. Unfortunately, even combinations of these techniques aren’t nearly 100% effective at permanently eradicating staph.

A staph eradication plan should be established with your physician, who knows your case and family well. Though it may not be possible to guarantee success, usually a combination of strategies will help at least reduce the chance of staph infections.

More information from The Minnesota Department of Health

Filed under: Medical problems


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