MRSA

[Grimey]

Superbug (http://en.wikipedia.org/wiki/Mrsa)

My 18 month old son just got out of the hospital with this. He was on an IV drip of some very strong antibiotic for five straight days. I had never heard of it before, but now it is everywhere (http://www.washingtonpost.com/wp-dyn/content/article/2007/10/16/AR2007101601392_pf.html). I have heard national radio show hosts talk about it, kids dying from it, epidimecs of it in places.

Needless to say, I am scared to death. He got ear tubes a couple of months ago because of chronic ear infections, and we noticed shortly after that he had pimples near his ear and the nastiest smelling drainage coming out of his ears.

I know what caused it, and wished I had known before what I know now. He took antibiotic after antibiotic each time he got an ear infection, until he finally built up a resistance.

Please pray for my little boy to get better. I am really frightened. And if you have a kid with chronic ear infections, talk to his/her doctor about not over-using antibiotics.

[Mongo]

thoughts and prayers sent

sorry to hear this Grimey

[tbl]

I just read about this yesterday. How is he doing right now? I'll be praying. Please let us know how he's doing.

[crawfish]

Sorry to hear that. :(

The wife of a friend of mine has that. They're missionaries in Honduras. How ironic and sad is it that after years of living with Honduran medical care, she catches it in a hospital in Fort Worth?

[TUSooner]

Prayers made.

[Okla-homey]

Prayers Up!

Is it viral or bacterial?

I think we need words from OUDoc on this.

[tbl]

It's a staph infection.

[Grimey]

It's like this just exploded into an epidemic all of a sudden. I mean National news stories about it on all the channels. You see these things and think oh, that'll never happen to me.

[nmsoonergirl]

Glad he's home and doing better, and I'll be sending thoughts your way for a continued recovery.

Homey, MRSA is a bacterial infection. 10-15 years ago, it was found only in the hospital setting, but now is out in the community. Interestingly, the community acquired MRSA is a completely DIFFERENT strain than the old hospital acquired one (so it's not a case of the hospital bug got out, the community bug morphed on it's own). And unfortunately, the community acquired bug is a much nastier bug than the hospital acquired one is.

When I started residency 6 years ago, about 15 percent of soft tissue infections that we saw in New Mexico were community acquired MRSA. Now that number is close to 90 percent. This means that we are having to use bigger gun antibiotics from the get-go. This is a problem for adults, but is even a bigger problem for kiddos, because it is UNBELIEVABLY difficult to get FDA approval for new antibiotics for children. So we are now treating all skin infections (and lots of other infections) with antibiotics that cover MRSA. In another few years, we can expect that MRSA will be resistant to some of the antibiotics we use now, and quite simply, we won't have enough new ones to use on the younger patients. I'm not worried about the bird flu, but I'm scared as hell of resistant bacteria.

Grimey, the CDC has some recommendations for family members of patients with MRSA (which include frequent linen washing, and even weekly baths in a weak bleach solution). I'm sure you can google it.

And everyone, STOP asking your doctors for antibiotics for your colds. The whole reason I chose not to do primary care is because I HATED having that argument with 40 parents a day....

[StoopTroup]

My thoughts and prayers are with you and your son.

I've wondered if down the road the Medical Profession will have to tear down these huge Hospitals and start having to limit a buildings use to temporary.

[Boomer.....]

That's horrible. Prayers sent.

[Tailwind]

Oh my, that's awful. Prayers sent for you and your little boy. I sure hope he is able to fully recover from this.

[SoonerBOI]

I just said a prayer...

[Oldnslo]

Prayers sent. Please update as soon as possible.

[achiro]

Prayers sent!

Question for those that have dealt with this. There has always been "mild" forms of Staph that show up as pimples or boils. Typical recommendation I always heard was clean regularly and use neosporin or something similar. Then use antibiotics for more stubborn cases. Now they are saying not to overuse antibiotics so I wonder a couple of things. Do they also mean not to use antibiotics on more "mild" staph cases? And how do you tell the difference visiually of a more mild strain verses the MRSA? If a child shows up with a basic furuncle or just folliculitis, should they be refered to a physician for a lab workup?

[olevetonahill]

IN
I hate hearing about younguns being that sick .

[OUDoc]

nmsoonergirl said it all.
achiro, MRSA can be cultured out if there is any doubt, but it looks different (typically) than other infections. However, the current treatment for MRSA is typically TMP/SMZ, which is a cheap, old sulfa antibiotic that should work for most skin infections. So, with the prevalence of MRSA, most of my skin infections get treated the same way now.
Good luck to your son, grimey.

[sanantoniosooner]

My son has MRSA. The one that recently had pneumonia X asthma

You might recall he also had what we thought was a brown recluse bite on his side. After consulting with several people and researching more, we believe it was a MRSA boil.

Pretty much you never get rid of the MRSA, from my understanding. It can live in colonies in the nasal passages and possible other places waiting for a chance to do some damage.

[OKC-SLC]

nmsoonergirl is right on.

It cannot be overemphasized enough that antibiotics are way overused. The buck stops with physicians, no doubt. But there are tons of patients out there who come in for viral sniffles demanding antibiotics and will doctor-hop (usually to urgent care settings) until they get antibiotics.

Achiro, I don't know that there is a magical way to know when what appear to be run of the mill mild skin infections are really more severe resistant ones. This is part of what nmsg was alluding to above--often, especially in areas of high MRSA prevalence, antibiotics which cover MRSA are started from the start empirically. If a local skin infection does not improve on more 'gentle' antibiotics (or if it worsens), get thee to medical center.

Grimey, I'm not a pediatrician, so I don't know alot about ear infections in kids. And it's not so much that he developed a resistance, but more likely that the frequent antibiotics resulted in killing most other bugs and allowed the once rare MRSA that have likely been community-acquired to take over. It's also possible he acquired it during the hospital setting when the tubes were placed in the ears. But there is no way to know if he truly needed antibiotics for these previous cases, so you must not feel that you in some way contributed to this. Kids are tough, man.

[OKC-SLC]

nmsoonergirl said it all.
However, the current treatment for MRSA is typically TMP/SMZ, which is a cheap, old sulfa antibiotic that should work for most skin infections.
This is true for superficial infections.

Doc, PO vanco doesn't get absorbed, right? So it's of no use in ambulatory MRSA? That's what I seem to remember.

[HskrGrl]

I am so sorry to hear about your son!! My prayers are with him!!

I have heard a little here and there about MRSA but I haven't really read any of the news stories yet. I will probably go do that now. Thanks for the info that you guys have given here.

[Newbomb Turk]

Hope your little boy gets better Grimey.

[soonerhubs]

Prayer sent.

[OklahomaRed]

Prayers sent.

You can actually do nasal swab cultures to see if someone is a MRSA carrier. You can decolonize their nares with Bactroban before surgery, etc. to minimize risk.

Bactrim and Cleocin both work pretty well orally. Some big gun antibiotics in the hospital setting; however, a lot of success deppends on how soon it's caught if it tries to go systemic. As far as the boils, incision and drainage works, followed by Bactrim.

[nmsoonergirl]

Cleocin (clindamycin) has induced resistance in about half of our MRSA here, so we tend to use Bactrim for our oral antibiotics (at least until our lab gets us the results of the Dtest). And yeah, SLC, po vanc isn't absorbed orally at all.

Grimey, believe me when I say that there a TONS of people out there who are colonized with MRSA who haven't had chronic ear infections, and it's very unlikely that any of his ear infections were caused by staph (other bacteria are the usual players for ear infections), so please don't second guess yourself or feel any guilt. In his case I think he was a victim of community resistance and not individual resistance, if that makes any sense. (it may not..i've been up for a long time and need some coffee.)

[mwmcl]

That is teh suck. Sorry to hear/read about that.

[Grimey]

He has been on Bactrim for the past week, and will be taking it until it runs out. The drip that he was on in the hospital was Vacamycin(sp?). His specialist is going to remove his ear tubes tomorrow and clean out the remaining mucas and then put in a fresh pair of tubes.

The latest cultures have shown that the bactrim is doing very well for him.

I'll try to keep updating. Thanks for the prayers.

[crawfish]

Here's an article released today on this very subject:

Staph Fatalities May Exceed AIDS Deaths (http://news.wired.com/dynamic/stories/S/STAPH_INFECTIONS?SITE=WIRE&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2007-10-17-07-48-15)

[crawfish]

Here's an article released today on this very subject:

Staph Fatalities May Exceed AIDS Deaths (http://news.wired.com/dynamic/stories/S/STAPH_INFECTIONS?SITE=WIRE&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2007-10-17-07-48-15)

I certainly hope nobody sees me as insensitive for posting this article. I felt it had good information that should be shared on the subject, and I think people do need to be informed about the condition. I'm toying with deleting the post, if anybody feels I should let me know.

I do understand how scary the situation you're in, Grimey. We spend two weeks a few years ago thinking my 9-year-old son had bone cancer. Thank the Lord it just turned out to be a bone infection. I have never been so scared and helpless in my life. You have my prayers.

[Blue]

prayers sent.

[limey_sooner]

Sorry to hear that. Hope your kid gets better real soon.They've been having real problems with it in the U.K. too. My nurse girlfriend says they see more cases every month.

[BigRedJed]

I had it. It was the succ. At first I thought it was just really nasty ingrown hairs. It wasn't. Did I mention it was the succ? One of the things not mentioned here is to stop -- I MEAN STOP -- using antibacterial soap. Anyone on here who has been to lunch with me knows that I am a compulsive handwasher.

I had antibacterial hand soap, took showers with antibacterial soap, every soap I had was antibacterial. Actually, my doc explained that helped create the problem. The antibacterial soap killed off all of the (weaker) "good" germs, and the MRSA had no competition. After several WEEKS of bactrim, I got better. Then, it came back. All told, I had probably 6 weeks of several different antibiotics. Believe you me, all of my soap at home is now NOT antibacterial. BTW, do you know how hard it is these days to find deodorant soap that's NOT antibacterial?

Did I mention that MRSA is the succ?

[Viking Kitten]

Admins, can we get a "BRJ's Health Issues" forum? TIA.:P;)

[BigRedJed]

Next topic: my cholesterol.

[Viking Kitten]

This thread is worthless without pics.

[BigRedJed]

WHATEVER YOU DO, don't do a GIS for "pics" with safe search turned off.

YWIA.

[BigRedJed]

And I'm NOT kidding.

[Grimey]

Quick update while I am at work for an hour. Lucas got the tubes replaced and they did a culture of the junk still in his ear. Staph is still there, so they are going to send him home with a Picc line in his arm. We actually had the Infectious disease doctor come and examine him. He is going to have him get vancomycin and rifampin through the picc line for a few weeks

Rifampin is big-time stuff, supposed to kill off the staph. It turns his pee, tears, sweat and all that stuff bright orange. It is going to be tough few weeks, but this is supposed to make my boy better.

Thanks for all the support.

[soonerboy_odanorth]

prayers for the little fella...

[FaninAma]

I never use single coverage for MRSA. At this point MRSA sensitivities at our facility do not show a lot of clindamycin resitance and the trait for inducible resistance of the organism to clindamycin is part of our routine culture and sensitiviy tests.

Clindamycin also achieves just as high tissue levels with the oral dosing as it does with the IV dosing which is a big advantage, IMO. So I still use a lot of Clindamycin because it gets better tissue and abcess penetration than Bactrim but I always combine it with rifampin to reduce the chances of the organism developing resistance. Of course, if our surveillance culture patterns change and the incidence of clindamycin resitance increases then I would use more Bactrim.

IMO, early drainage of any abcesses is the key to a successful outcome.

And yes, physicians overuse antibiotics and should be more willing to say no to their patients. But patients also do a great deal of harm by not being compliant and not finishing the full course of their antibiotics.

Grimey, I hope that your little boy does well. From his history it sounds like he may very well have the less invasive community aquired form but you still don't won't to mess around with it. It sounds like he is getting excellent care.

[NormanPride]

Hopefully he'll be back in school in a few weeks telling all the other kids how cool it was to have orange pee. You can tell him he's peeing the aggy right out of him. :)

Prayers sent your and his way, of course.

[OKC-SLC]

Great to hear, Grimey. It seems like your kid's doctors are taking the bull by the horns, which is good.


IMO, early drainage of any abcesses is the key to a successful outcome.

But patients also do a great deal of harm by not being compliant and not finishing the full course of their antibiotics.
Both excellent points.

[soonerboomer93]

I hope he gets better soon Grimey