CA-MRSA : Facts, Fiction, and Strategies

This past summer, a fourteen-year-old came to my adolescent health center complaining of a blistering rash. “Is this the ‘super-bug?’” his trembling Mom cried out. “No,” I reassured her, “it is merely a case of poison ivy.” Many sighs of relief.

As the director of a large ambulatory network in the metropolitan New York region, I hear, on a daily basis questions like:

• Is this “super-bug” new?
• How can I prevent catching this killer strain?
• Should my school shut down since they found MRSA (Methicillin-resistant Staphylococcus aurues) there?
• Is there any treatment for it?

The Facts:

The so-called Methicillin-resistant Staph germ (MRSA) has been around for many, many years. Like the “flesh-eating” hysteria of last year, there are myths and truths that may help to set the record straight.

• Staphylococcus aureus (“staph”) is a common germ (i.e. bacterium) that is carried on the skin or in the nose of approximately 30 percent of healthy people. Most never develop any symptoms or illness. Staph is a leading cause of skin and soft tissue infection and when an infection does occur, it is usually mild and without consequence. 
• Infrequently, staph infections may go deeper to form a boil or abscess. Such so-called “invasive” staph infections are different from skin and soft tissue infections and are more serious.
• Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph which is resistant to some of the antibiotics that typically have been used to treat skin and soft tissue infections. Although commonly and historically found in hospitalized patients, “community acquired” MRSA (CA-MRSA) is showing up outside of hospitals. Although an intuitive link exists between hospital-acquired and community-acquired MRSA, the jury is still out on this causal relationship. As is MRSA, CA-MRSA is resistant to methicillin and other penicillin type antibiotics such as amoxicillin and the cephalosporins, but there are medications which are effective—including vancomycin, clindamycin, and trimethoprim-sulfamethoxazole.

How does CA-MRSA spread?

Staph infections are spread by direct physical contact with the bacteria, almost always person-to-person, but can be spread through contact with contaminated surfaces, personal items, or equipment. Spread of staph infections may occur through skin-to-skin contact when playing sports, such as football or wrestling, or from surfaces in gyms and locker rooms.