MRSA, now what?

“I have MRSA, now what?”

Courtesy on www.medicinenet.com

MRSA, (pronounced mersa), is a word that often evokes worry, fear and concern among patients and families.  Here’s a little information that hopefully will help clarify the diagnosis and bring some clarity to your worries.

What is MRSA?  MRSA is an abbreviation for Methicillin Resistant Staph Aureus.  So, what does that mean? Staph Aureus is a common bacteria that often can live on the skin and can cause skin infection of wounds.  It is a common culprit in skin infections like impetigo that have been around for many years.  MRSA is different because this particular strain of bacteria is resistant to Methicillin (or penicillin) antibiotics. In years past, we wound treat skin infections with two major classes of antibiotics, penicillins and cephalosporins.   MRSA is often resistant to these two classes of antibiotics.  What happened in the early years of MRSA development was that we would treat with the old tried and true antibiotics and the infection got worse, leading to sometimes life threatening infections that spread throughout the body.

How does my doctor know for sure that I have MRSA?  MRSA is diagnosed with a bacterial culture.  A cotton swab is rubbed on the suspected area and then is sent to the lab for a bacterial culture.  It usually takes at least 3-4 days to get a result.  The result of the bacterial culture tells us exactly what bacteria is causing the infection and exactly which antibiotics will effectively kill the bacteria.

Where does it come from?  MRSA is contracted from skin to skin contact with someone who also has the bacteria.  In addition to the skin, many people have MRSA growing inside their nose or other moist areas on the body.  So, contacting nasal secretions to an open wound could also lead to infection. Some people have MRSA growing in their nose, but are asymptomatic.  We call an asymptomatic infected person a carrier of MRSA.  Let me explain, when I was a child I had strep throat a lot.  At some point, we all went to the health department and had throat cultures.  We found out the one of our family was a Strep carrier.  So, to end my frequent infections we had to treat the carrier as well.   This is why we sometimes treat the whole family as I will describe below if a family has had repeated MRSA infections.

How is MRSA treated?  A number of scientific studies have shown that for a MRSA abcess (a pus pocket in the skin), simply draining the abcess can help an infection to resolve.  However, in my experience, if oral antibiotics are not used, the patient will soon develop another infection.  Using the bacterial culture result as I described above, we treat with oral antibiotics often for 2-4 weeks.  I usually treat an initial case with a shorter course.  For those with repeated infections, I often treat for one month.  In addition, to taking an oral antibiotic, I also recommend treating the area topically.  Not all topical antibiotics successfully treat MRSA.  I usually prescribe mupirocin to treat topically a few times a day.  In my experience using this topical also aids in healing of the spot.

How can I avoid getting infected again?  Not everyone will agree with these recommendations.  However, in my experience, patients who follow these suggestions rarely have a repeat infection.  Many patients who come to see me after struggling for years wish they had done this on the initial infection.

• Wash with an antibacterial soap at least a few times a week and more often if you are having frequent skin to skin contact with others who may be infected. This especially includes health care workers and athletes.  With the , this may require a prescription from a doctor for a surgical scrub like chlorhexidine or a sulfur based wash.
• Use mupirocin ointment on every little cut and scrape and pimply like spot that anyone in the household develops twice a day until the spot heals. Mupirocin ointment is also by prescription only.
• This last one I especially recommend to those who have had repeated infections. Everyone in the household and all close contacts can treat their nose with mupirocin. Yes, put the ointment up your nose, twice a day, every day for 5 days.  Everyone do it on the same 5 days.  Then repeat this procedure in 2-3 weeks.

What about the rest of my family and other athletes?   I would recommend avoiding skin to skin contact until the area is completely healed over.  In the meantime, keep mupirocin on the spot and keep the area(s) covered.  Clean sports equipment regularly and use antibacterial wipes to clean sports equipment.  You can find the 

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