MRSA - The New Cooties

As a child in rural Pennsylvania, one of the first afflictions that boys learned about was cooties. We assumed that cooties were a subspecies of head lice that usually just affected girls. If a girl had cooties, it would be best not to sit near them, or God forbid, bump in to them. Simply touching a girl (anywhere; not in those taboo places) would give you cooties. Cooties could be cured simply by touching someone else; transferring the affliction.

The other day in my clinic, I asked a six year old boy if girls in his school still have cooties. He replied that they do not. He nonchalantly said that girls have MRSA! I could not believe that a six-year old knew this highly-technical, medical abbreviation.

"MRSA!" I said. "Do you have any idea what that is?"

"Yes, it is a Staph infection." My jaw dropped. This kid has been watching the news.

There have been several cases of MRSA - Methicillin-Resistant Staphylococcus Aureus - reported in the local schools and day-care facilities and our local, sensation-gathering news media has again, scared the heck out of everyone. Some schools have been closed while janitors, masked and wearing hazardous material suits, are disinfecting everything. Parents are bringing kids into the clinic with innocent-appearing rashes; hoping that their child does not have MRSA.

The last time that I saw a panic like this is when a local high school had three cases of meningitis. The very next day, every lethargic-looking teenager (most of them) with a stiff neck was hauled into our office by frightened parents so they could be tested.

MRSA has been around for long time. We have been regularly finding it on some of our patients, especially the last few years. In one week, I found two different teenagers with abscess on their buttocks that tested positive for MRSA. Another doctor in the clinic, found two more MRSA-positive skin abscess in the same week; also on the butt. The kids went to different schools; unlikely that they would have been sitting on the same toilet. A few weeks later, I saw a nine-month old with an odd diaper rash that was blistering. Although Strep is commonly found in this area, I sent it out for culture. This little girl had MRSA, too. This time, a source was narrowed down. Dad was an RN; Mom was a respiratory therapist. They both worked in the hospital. It is likely that MRSA hitchhiked home on their scrubs, or hands...or both.

Fortunately, all of these cases were cured with a simple antibiotic; one that we rarely use anymore for skin infections - sulfamethoxazole (Bactrim, Septra). In the past, we used to use this older drug for ear infections and it is still the number one drug used for urinary tract infections. As new antibiotics were developed, medical providers jumped to use them instead. Now, thanks to this old sulfa drug, we are able to cure some of these cases, but unfortunately, not all of them. One of the reasons sulfa is working is because we stopped routine using it. MRSA, so far, hasn't developed a universal resistance to it.

A few weeks ago, my elderly father-in-law passed away. Although there were several causes of his demise listed on the death certificate, one was septicemia - an infection throughout his body. As a diabetic, he recently had a partial amputation of his foot performed at the hospital and acquired a post-operative infection. Septicemia due to MRSA was partially responsible for his death.

I started worrying about myself. Since I decided to limit my practice to pediatrics, I get my share of upper respiratory infections. A few times per year, I get a difficult-to-treat sinusitis. A month ago, I developed my first case of pneumonia. While I don't have any skin sores, I did swab my nose for MRSA. Negative. Since I see newborns; even a few micro-preemies (babies that only weigh a few pounds), I definitely do not want to be carrying a potentially deadly bacteria.

I literally wash my hands three times with each patient; including the use of a hand sanitizer. I gave up my wild collection of pediatric neckties after reading a study that neckties can carry germs. I disinfect my stethoscope. Although I do wear the same clothes all day, I try my best not to contaminate them. This is a more difficult task since I really like picking up kids, accepting hugs, and playing with babies. I try to keep my distance from children that I know have infections, but you never know when a free-flying sneeze will hit you square in the face. I certainly glove up for kids that have skin infections and I routine culture suspicious wounds for MRSA.

MRSA is a super-bug. Although Staphylococcus has been around since there were humans, we have only been using antibiotics since the mid-1930s. Guess what? The first antibiotic that was ever developed was sulfa; even before penicillin mold was observed growing on bread. Sulfa saved countless lives in World War II. Right now, we can use sulfa again for some of these infections, but for how long? If medical providers start randomly using sulfa again for all infections, MRSA is certainly going to adapt. Then, we will be left with a few, potentially-toxic, ultra-potent IV antibiotics. Some hospital-borne infections are resistant to ALL antibiotics. When that happens, the patient often dies.

While MRSA is not freely jumping from kid to kid in our schools, or affecting every patient in hospitals and nursing homes, it is a real threat and the numbers of community cases are growing. I am not surprised that teachers and health care workers are frightened. We are now at the threshold of MRSA Madness, when every sore, zit, scratch, or red spot is MRSA until proven otherwise. Kids are being excluded from school and sports, and of course, medical clinics. If diagnosed in the early stages of a skin infection, community-acquired MRSA is treatable. Now, hospital-acquired MRSA is another issue altogether. Some of those bugs are resistant to ALL antibiotics. We definitely don't want these strains showing up at day-care.

MRSA - Coming Soon to a School near you. Personally, I think they should have been disinfecting those school rooms long before MRSA made its debut. Picking up the trash and moping the floor is NOT the same as thorough disinfection. Unfortunately, even if school rooms were operating room clean, they would immediately become contaminated again, as soon as the children return. We really don't have a good way of decontaminating kids so MRSA is going to keep spreading.

Kids and germs have always been inseparable pairs. As much as we love them, children have always practiced a lower form of personal hygiene than most other humans. When kids start bringing MRSA home from school, we need to take notice and we need to take action. Newer and safer antibotics are in the works, but those, too, may become ineffective if MRSA continues to adapt. There is even a MRSA vaccination in the works.

We ain't dealin' with just cooties anymore.

Related Topics:

• MRSA: Experts Answer Your Questions
• WebMD Video: Preventing Staph Infections

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