Paging Dr. Alan Frischer

Paging Dr. Alan Frischer - Staph/MRSA

By Dr. Alan Frischer
2009-01-09 Edition

In recent years we have experienced an unprecedented new epidemic of skin infections caused by the bacteria staphylococcus aureus, commonly known as staph. Even tougher, deadlier, and more expensive then staph, however, is MRSA. What are these skin infections and how can we avoid getting them?

Staphylococcus aureus (staph) are bacteria commonly carried on the skin or in the nose of healthy people. It is estimated that as many as 30% of us are colonized (bacteria are present but not causing infection). When staph does cause an infection, it usually results in minor pimples or boils on the skin. Sometimes, however, these pimples or boils can become major abscesses. Staph can also cause serious infections of the bloodstream, infections of surgical wounds, or pneumonia in susceptible people.

MRSA (pronounced “mersa”) stands for methicillin-resistant staphylococcus aureus. It was discovered in 1961 in the United Kingdom and is now found worldwide. According to the CDC (Center for Disease Control), annual MRSA deaths in the U.S. grew from 11,000 in 1999 to 18,650 in 2007, a number greater than U.S. annual deaths from AIDS!

Of the 30% of people who are colonized with staph (as determined by swabbing the nostrils), 1% are colonized with MRSA. While staphylococcus aureus is a common and treatable bacterium, MRSA is resistant to antibiotics in the beta-lactam and penicillin families, which include methicillin, oxacillin, cephalosporins, and penicillin. This resistance makes treating MRSA infections very difficult. Healthy people may carry MRSA without symptoms for weeks or for many years. People with compromised immune systems (including the elderly, and those suffering from AIDS, diabetes, and various cancers), are at a significantly greater risk of developing symptoms from the MRSA they have been carrying. Other people at risk include athletes in contact sports, children, and prisoners.

Staph/MRSA infections occur most frequently (about 88% of the time) in hospitals, nursing homes, dialysis centers, and other healthcare facilities where people have weakened immune systems. The initial presentation of MRSA is small red bumps that resemble pimples, insect bites, or boils and may be accompanied by fever. Within a few days the bumps become larger, painful and eventually develop into deep, pus-filled boils or abscesses. Occasionally, it is necessary for a doctor to open up a MRSA abscess with a scalpel to let it drain properly.

When infection occurs outside of hospitals and healthcare facilities, it is known as community-acquired MRSA. Community-acquired MRSA typically occurs in an otherwise healthy person. The ultimate infection tends to be much milder. Factors that are associated with the spread of MRSA skin infections include close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.

Treatment for MRSA infections involves the use of costly non-resistant antibiotics. While the gold-standard treatment has been the antibiotic vancomycin, new resistant strains of MRSA are no longer responding to it. These new strains are termed vancomycin intermediate-resistant staphylococcus aureus (VISA), and as you can imagine, are even more difficult to treat.

Unfortunately, a MRSA infection can return; staph may continue to colonize the body even after the initial infection is cured. When there is a new skin break, the bacteria may create a new infection. To remove staph from the body and prevent recurrent infections, patients use an antiseptic soap and apply an antibacterial ointment to the nostrils.

The key to controlling staph infections is prevention:

Keep your hands clean by washing thoroughly with soap and water, or use alcohol-based hand sanitizers

Keep cuts and scrapes clean and covered with bandages until healed

Avoid contact with other people’s wounds and bandages

Avoid sharing personal items such as towels or razors

Speak with your doctor if you develop a skin infection that does not heal.

Good health to you all!

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