Doctors Lounge - Infections Answers
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Forum Name: Other infections
|brandycheek - Wed Sep 24, 2008 3:49 pm|
My 3 year old fell this past Saturday and got an abrasion on her elbow. She developed an infection and we are waiting on the culture to find out if it is MRSA. They have already started her on Bactrim in case. My question is if the test is positive, will she always be a carrier of MRSA? If yes what does that mean, that it bascially lays dormant in the system unless there is a cut or wound of some sort or is it active in her body forever? Also since she is in preschool, would it be wise to encourage all parents to have their kids tested for colonized MRSA and do physicians treat you for MRSA if you are found to be a carrier. Thank you so much for your help. There is so much information out there but a lot of it seems to contradict each other so I would appreciate some clarity.
|John Kenyon, CNA - Fri Oct 10, 2008 11:14 pm|
MRSA is a group of strains of staphylococcus aureus ("staph"); about 30 per cent of the general population is colonized at any given time, and a substantial portion of that group carries a MRSA (methecillin-resistant staph. a.) form, usually in the nasal passages. The vast majority don't have any infection or symptoms, but can always pass it along to someone else (almost always be direct or secondary environmental contact) who might become infected. It is not necessarily a permanent, latent contamination, but can stay "on board" for exteneded periods of time. If treated, it can be killed, but it's so common in the general population that it's likely to show up again at some point anyway.
The greatest help in dealing with MRSA or other staph contamination is to treat infections when they appear, and to take appropriate precautions to avoid exchange of the microbe when there is a known infection (which is usually present on the skin, but can, especially in the elderly and debilitated, invade the respiratory tract and other organ systems). It's not, by its mere presence, a remarkable problem, but has garnered a lot of public awareness because of its having caused so many problems in institutions, especially hospitals (where there are already large populations of sick people who are automatically more vulnerable to any microbial infection anyway). The overuse of certain antibiotics has been blamed for the apparent increase of certain resistant strains, but they've always been out there, and are always adapting.
MRSA is not active in one's body forever, or even necessarily ever, although it may be present at times. It is usually not tested for unless there's reason to suspect there may be an infection of if there has been exposure to someone who is infected or colonized. Most of us have some form of staph on board at some time or other, but it usually passes eventually, only to return some other time. We may never know unless we develop an active infection, but that can be from a totally new and different crop.
In short, your daughter isn't part of a "carrier" subset, she just may be colonized currently, in which case appropriate precautions can be taken until she no longer tests positive. She'd only need to be treated if she showed signs of active infection.
I hope this is helpful.
|brandycheek - Mon Oct 13, 2008 2:17 pm|
Thank you for your help. The information was helpful. My daughter did in fact test positive for MRSA and was treated for 3 days with Bactim but due to a rash that developed the medicine was changed to Clindamycinfor 4 additional days. Now two weeks after finishing treatment she has MRSA again in a different area. I am concerned that her pediatrician is taking a lackadasical approach in treatment such as no followup after treatment to even determine if she was colonized and for this bought of MRSA they are not even recommending oral antibiotics only Bactroban on the site. We are swabbing all of our noses this time around, but how do they know if the first treatment eradicated the MRSA or maybe it is still in her system and that is why she got it again so soon? I am concerned about it getting into her bloodstream but I cannot seem to get her pediatrician to even do a blood tet. They just seem to not be concerned about it at all. Hope you can shed some light.
|John Kenyon, CNA - Mon Oct 13, 2008 7:49 pm|
Hello again -
While the MRSA problem is a major annoyance in general, it is mostly a big problem in institutional settings, which may be why the doctor is taking an overly laid-back approach. I'm rather surprised, since it (MRSA) isn't something anyone wants or needs circulating in a household, either, and it's such a simple process to test for colonization. The failure to at least do that really is perplexing, since it could easily be eliminated, at least for this time around, and you all could be saved a lot of aggravation, trips to the doctor, time off work, etc. Maybe a second opinion would be worthwhile. At least perhaps the nasal culture could be done and then you'd know if the bug is there or not, so that you could maybe get some sort of pro-active attention.
It's not generally a terrible thing, but if it can be eliminated, that's obviously all the better. There's such a thing as a doctor being a little too laid back about a problem. It's still health vs. illness. You'd think that would be a no-brainer. Ah well...
Thanks for your follow up. I'd definitely press the issue and/or seek a second opinion. Good luck with this, and please do stay in touch.
|Jessie53 - Fri May 15, 2009 11:07 am|
My cellulitis is gone but last time I was at hospital they said I tested positive still.
Are they not treating because there are no lesions?
What about my white blood cell count? Is that only an issue if there is visible activity on the skin?
Lastly, when I get a scratch, scrape, etc. I am freaking out that MRSA will crawl in and start this all over.
I've been cleaning with instant sanitizer and triple antibiotic. Do I need to go all the way and bandage every little break in my skin?
I do not want to go through cellulitis again!
|John Kenyon, CNA - Fri May 15, 2009 2:43 pm|
Hello again --
The fact that the cellulitis has resolved but you still test positive for MRSA is not surprising. Most of us who have been exposed are either colonized or become recontaminated because this bacterium is everywhere. Countless thousands of people are walking around with it dormant. Sometimes something allows it to stir to life, other times it's passed to someone else, but mostly it just sits around doing nothing. Knowing you have it is helpful, and allows you to decide what sort of precautions you might need to take. Most of what you're doing now is probably useful, same as someone in the healthcare industry who's exposed on a routine basis might do: careful and appropriate hand washing, use of hand sanitizer, etc., is likely the most you can reasonably do without driving yourself crazy. I don't think you need to freak out at every scratch or scrape. Just do what you're doing and be aware that the thing could start up again. If you're observant you can likely catch a nascent infection before it advances to cellulitis (if this should ever happen, which is only slightly more likely for you than the next person at this point) and handle it appropriately. This should not now be an unusual situation nor a reason to live as though walking on eggshells, in a state of high alert. I wouldn't banadage every break in the skin, just clean those and be observant, as anyone really ought to be.
No one who's had cellulitis wants to go through it again, and most don't. You're in good company. You're doing everything right, so I think you can start thinking of yourself as a normal healthy person who is painfully aware that this problem is out there, and so just be a little more aware and careful to avoid it. We should all be so aware.
Good luck to you. Please stay in touch with us and update us as needed.
|Jessie53 - Sat May 16, 2009 6:31 am|
Thank you so much! So, I should not worry about my white blood cell count if there is no visible infection?
I was not able to take the oral antibiotics/other meds prescribed after leaving the hospital (September '08) which has left a lingering worry.....
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