Abscesses – What to do about MRSA (Methicillin-resistant Staphylococcus aureus)

IMG_5872“Staph” infections are most often caused by the organism Staphylococcus aureus, a bacterium that is carried on the skin of about 30% of healthy individuals.  Most of the time, these bacteria do not cause any symptoms. They just hang out on the skin because the skin is a natural layer of defense against infections.  If the skin is damaged, even from a small scratch however, Staph can cause anything from a mild skin infection to a severe, life-threatening illness, especially in young children or older adults.

The difference between normal Staph infections and MRSA Infections:  Staph infections in the past were treated with antibiotics such as penicillin.  Some strains of Staph have unfortunately become resistant to penicillin and related antibiotics.  These strains of MRSA cannot be cured with traditional penicillin-related medications.  MRSA is now found in up to 70% of people in the community with a diagnosed staph infection.

The spread of MRSA:  Many people become “colonized” with MRSA and that means that they carry the bacteria on their skin or in their nose.  It doesn’t cause any problems unless there is an opening in the skin from a scratch or cut.  You can become colonized with MRSA bacteria in several ways:

1)   Touching the skin of someone else who has been colonized with MRSA

2)   By touching or inhaling small droplets from breathing, coughing or sneezing

3)   By touching a contaminated surface such as a phone headset, countertop or door handle

Community MRSA:  You can more easily pick up MRSA by:

1)   Being overweight or obese

2)   Shaving body hair

3)   Sharing personal items or equipment that is not cleaned

4)   Skin trauma such as turf burns, cuts or sores

5)   Physical contact with someone with a draining cut or sore that has MRSA

Symptoms:  A skin infection is the most common symptom and it may be mistaken for a spider bite.  A raised, red lump that is tender or cluster of  “pimples,” or large tender lump that drains pus may also be present.  If the bacteria enter the bloodstream, it is possible to develop an infection in areas other than the skin.  A staph infection can occur in a heart valve, inside a bone, a joint or in an implanted device such as an IV line, pacemaker or replacement joint.  Symptoms of these types may include fever, fatigue as well as swelling in the infected area.

Diagnosis:  To actually diagnose a true MRSA infection, a culture of the infected area must be performed.  A small sample of bacteria or pus collected from the skin or bloodstream is collected and allowed to grow in an environment that the bacteria thrive in, and then we test these bacteria for resistance to certain antibiotics, including penicillin.

Treatment:  in patients with community acquired MRSA we use antibiotics that may be different than patients who develop MRSA in the hospital.  This is because community acquired MRSA is usually sensitive to antibiotics such as Bactrim, clindamycin, or doxycycline.  MRSA that is acquired in the hospital often has to be treated with antibiotics given through an IV such as Vancomycin.

A surgical procedure called an I&D (incision and drainage) can be done to drain the pus and heal the infection.

If you’ve had an incision and drainage done at your doctor’s office:  After having a surgical procedure done at your doctors office, the wound is often packed with sterile gauze to allow the wound to heal from the bottom upwards.  This way, the wound doesn’t close up at the top and leave a space underneath the top of the skin where bacteria can start growing and cause an infection.  This type of wound needs special attention and observation each day.

Basics of wound care after an I&D (incision and drainage):

1)   Keep the bandage/wound clean and dry.

2)   Only remove the bandage to clean around the wound and follow the advice of your medical provider on how to do this.

3)   The packing gauze should be removed little by little until the wound heals completely.  The decision on how much to remove (if any) should be made by a medical provider but this can be explained to the patient on an individual basis (ie. Wounds heal differently depending on the situation).

4)   You may need to wear a splint to decrease movement to the area and allow wound healing.

5)   Antibiotics and pain medication may be prescribed.

Prevention:  The CDC has made several recommendations about how to prevent and control MRSA in our communities:

1)   Wash hands with soap and water paying special attention to the fingernails, wrists and between the fingers.

2)   If a sink is not available, alcohol-based hand sanitizers are a good alternative.

3)   Cover all cuts and scrapes and keep them clean until healed.

4)   Don’t touch wounds or bandages from other people

5)   Avoid sharing towels, razors, clothing, uniforms, towels, brushes, combs, make-up and towels.

6)   Athletes should shower after every sports activity and use soap and clean towels.

7)   Exercise equipment at sports clubs and schools should be wiped down with an alcohol-based solution after using it.

Care for family members:  Our guidelines do not recommend that family members with MRSA be treated with antibiotics.  Proper preventative measures as described above, should be used.

Should I be tested?:  Experts do not recommend widespread testing for MRSA because of the small risk of infection.  Currently only 4 out of 10,000 people in our communities develop a MRSA infection per year.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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