A nationwide increase in antibiotic-resistant staph infections, including some in the Central Texas area, may be of concern to area residents, especially those who participate in contact activities, such as sports, play or even hugging. The bad news is that it appears to be increasing; the good news is that it is still possible to effectively avoid it most of the time.
"In 1995, we first started seeing a significant increase in community-acquired methicillin resistant staphylococcus aureus (MRSA)," remembers Pat Crocker, DO, medical chief of staff for the Dell Children's Medical Center of Central Texas emergency department. Dr. Crocker spent more than 20 years running both the adult and pediatric emergency departments at Brackenridge Hospital and the then-adjacent pediatric ER. "Prior to 1990, we rarely - if ever - saw MRSA outside the hospital setting."
"Last year, the emergency departments associated with the Seton Family of Hospitals confirmed about 3,700 MRSA infections," he continues. "Unfortunately, that probably underestimates the scope of the problem in Central Texas because physicians do not culture every abscess. Since non-hospital based MRSA infections are not a reportable disease, there is no accurate data on true prevalence."
Staphylococcal bacteria is commonly found on the skin and in the noses of all people. The Centers for Disease Control and Prevention estimate that almost 33 percent of the civilian population carry staph organisms. The bacteria can be transmitted by touch and infections usually present as skin abscesses, sometimes appearing to be pimples.
"Studies indicate that one to 25 percent of individuals may be colonized already with the antibiotic-resistant strain," adds Dr. Crocker. "The primary change we've seen since 1995 is that of all the staph infections cultured, only 20 percent were MRSA. Now, it's closer to 70 percent."
Several Central Texas schools have reported outbreaks of staph and many are taking precautions to promote increased hygiene and disinfect environments."The reassuring thing is that most of the time, someone infected with MRSA can be treated with draining the abscesses and antibiotics. MRSA is still sensitive to some of the older antibiotics that are common and low-cost. The problem is that the more we use them to treat MRSA, the more likely it will ultimately become resistant to them, too, adds Dr. Crocker.
If a patient doesn't get better with simple antibiotics, the options are much more expensive and potentially more toxic antibiotics.
How Staph is Spread
Because MRSA is easy to transmit, everyone is at risk for exposure. Some areas where transmission is common include schools, child care facilities, retirement homes, businesses and homes. According to the Texas Department of State and Health Services, it can be transmitted in the following ways:
- Poor hygiene, especially lack of hand washing
- Close personal contact (such as athletes or children's play) and crowded conditions
- Sharing personal products
- Lancing (puncturing/picking/piercing) boils with fingernails or tweezers
- Activities that result in burns, cuts or abrasions or require sharing equipment
Intravenous drug use, unsanitary tattoos and body piercing; inadequate access to proper medical care, especially due to inability to pay; and just being a child or young adult also raise risks.The Department has issued a report entitled Prevention and Containment of Staphylococcal Infections in Communities that provides substantially more information, including specific resources for schools, athletic organizations, group care providers, service providers and workplaces.
Identification of MRSA
"If you have a skin abscess - a small, tender, red sore that enlarges and gets more tender and red over the course of a day or two, it's a good idea to have it seen by a physician and not wait," advises Dr. Crocker. "Don't try to squeeze or drain the abscess yourself. Some of the larger abscesses have been associated with patients attempting to squeeze or drain the fluid themselves."
Staph infections (including MRSA) cause skin infections with the following characteristics:
- Pimple, boil or swollen sore
- Red and painful
- May contain pus or have other drainage
The Texas Department of Health Web site has photos of examples of staph infections of the skin. Please be aware before accessing that TDH warns users in advance that the material is graphic.
GoodHealh.com's online encyclopedia offers a symptom checker for skin problems to help determine whether to seek care.
"Hand washing and good personal hygiene is the best way to combat the infection, particularly before eating, drinking or touching your face," says Dr. Crocker.
Here are some practical tips for prevention:
- Wash your hands frequently and thoroughly with soap and warm water or use an alcohol-based sanitizer.
- Keep open sores such as cuts and scraped clean and covered with a bandage. Avoid contact with other people with sores or bandages.
- Do not share personal items such as towels or hygiene products.
- Use antibiotics correctly by taking all of your medicine if prescribed by a doctor. Using only part of a prescription allows antibiotic-resistant bacteria to grow.
- Use antibiotics only to treat bacterial infections and do not take leftover medications or prescriptions for others.
GoodHealth.com's online Health Encyclopedia has much more detailed information on MRSA.
The Centers for Disease Control and Prevention offer extensive information on community-based MRSA on their Web site.
Of all the cases of MRSA reported in the United States, the CDC reports 85 are still hospital-based.