Wednesday, December 21, 2011

Meeting Mr. Sa (a.k.a. Frank Pus)

As a working mom, I accept that my toddler is going to be exposed to drool, snot and microscopic fecal contamination from his fellow daycare inmates.  But I draw the line at pus.  So imagine my dismay when one of my son's caregivers pulled me aside and said, "I get a lot of boils. Would you mind taking a look?"  Whereupon she rolled up her shirt, revealing a lovely specimen, which fortunately had already burst and dried up.  Most boils and abscesses are caused by Staphylococcus aureus, and in my area, about 60% are methicillin-resistant.

MRSA (along with some forms of strep) is commonly described as the "flesh-eating bacteria" in the media.  While MRSA can result in serious, life-threatening infections, more often it causes nettlesome skin infections that may require incision and drainage and treatment with specific classes of antibiotics.  The classic presentation is that of a "spider bite," sans spider.


It used to be that MRSA was seen primarily in hospitalized patients, but in the past 10 to 15 years, we've seen a meteoric rise in a particular strain in the community.  MRSA is contagious, and pediatric outbreaks have been described in daycare centers and on sports teams.

So what can you do to protect your child?  Unless you plan on raising a bubble boy or girl, MRSA is not entirely preventable.  It's best to avoid sharing sweaty sports equipment and towels, which are often colonized.  And there is another thing you can do to reduce the risk: Avoid unnecessary antibiotics.  Antibiotics wipe out the good bacteria with the bad, allowing resistant strains to flourish.  And many conditions frequently treated with antibiotics, such as ear infections, tend to resolve on their own anyway.

A recently published study looked at all the MRSA diagnoses in kids from 400 general practices in the U.K., and compared them to same-age controls.  They then looked at the kids' exposure to antibiotics 1 to 6 months prior to the MRSA infection.  Children who were infected with MRSA were three times as likely to have received antibiotics during that time period than those who weren't infected.  The more antibiotics received, or the stronger the antibiotic (i.e., those with the broadest spectrum of activity), the stronger the association.  Of course, it's possible that a child receiving multiple antibiotics is just more prone to infections, and the antibiotics per se are not causing the MRSA.  The authors still found a correlation after controlling for baseline diseases, such as diabetes and asthma. 

Here's another disturbing possibility:  some of those kids might have actually picked up the MRSA from the doctors' office.  Healthcare workers have colonization rates of up to 15%, and you know that most of us don't wash our hands after we pick our noses.  Even worse, one study found that a third of stethoscopes in one ER were contaminated by MRSA.  Since I work in a hospital, I could hardly blame my daycare if my son had become infected.

Bringing home the superbug

I admit I was caught flat-footed by this curbside consult, and I ended up advising my son's caregiver to see her own doctor.  I told her a little about decolonization protocols, which involve bathing with antiseptics, taking antibiotics and lacing your nostrils with Bacitracin.  Unfortunately, unless you place all your clothes, bedding and pets on a bonfire*, re-colonization is the norm, so these protocols aren't often used.  Though I told her she had a bacterial infection, I avoided using the M-word in front of the other parents.  I also didn't recommend staying home during her outbreaks, though I did suggest she cover up her boils with gauze.  Afterwards I tried to hand off my kid to the other providers as discreetly as possible.  This happened many years ago, and I still wonder whether I did the right thing.

What would you have done?

*Kidding!  I don't want to be held responsible for any hamster roasts.


  1. Oh that's awful. I worked for awhile in urgent care, where we saw MRSA all day every day. Covering it is certainly the best thing and first priority, but I hope she saw a doctor and at least attempted decolonization. Lately I have been telling people the M-word, as it tends to get them to take it a little more seriously. As far antibiotic overuse, it is so difficult to get it through to people. And when your son, (as my Jojo was 2 weeks ago) cries for 6 hours straight and Motrin doesn't help, it is hard not to run to the doctor for an antibiotic. He turned out to have bilateral ear infections, which were treated with amoxicilin, but I probably could have waited it out without antibiotics, I know. But it's hard!!!

  2. It is very tough to wait out an infection. I usually try to do it, but a couple of times I had to give my kids antibiotics anyway, and then I cursed myself for not starting treatment sooner!