Community-Acquired MRSA Skin Infections 

What is MRSA?

Staphylococcus aureus is a germ that is usually found on the skin and nose of healthy people and usually does not cause problems. Staphylococcus most commonly can cause skin infections if the skin is damaged or wounded and can be treated with antibiotics. However, methicillin-resistant Staphylococcus aureus (MRSA) is a type of this bacteria that is commonly seen in the community and does not respond to common antibiotics used for treatment.  Staphylococcus (including MRSA) can also cause other types of infections in the lungs or blood as well. 

What does MRSA skin infections look like?

Staphylococcus infections of the skin can be red and tender to the touch like a pimple. It can also be mistaken for a spider bite because it can sometimes result in a black area of skin surrounded by redness. MRSA is more likely to cause skin infections that have pus and look like boils than common staphylococcus. The doctor should evaluate any skin infection that causes a child to be tired and have fever.

How is MRSA spread?

MSRA usually is spread from person-to-person, but can also be spread by touching surfaces contaminated with MRSA (towels, razors, etc). Children can get MRSA infections by playing contact sports, sharing sports equipment or towels. It is important to avoid touching the wound of a person with MRSA to prevent further spread.

How are community-acquired MRSA skin infections treated?

Treatment for community-acquired MRSA skin infections depends on the seriousness of the infection. Options may include draining the infection and/or taking an antibiotic. If there is fluid or pus under the skin, it may need to be drained.

Do not attempt to drain the infection yourself. This could cause the infection to worsen or to spread to others. If the child shows no other symptoms of infection, this may be enough for treatment; however, your doctor may also prescribe an antibiotic.

Antibiotics

In addition to drainage, community-acquired MRSA skin infections can be treated with antibiotic medications. Your doctor will prescribe the appropriate medicine for your child based on his/her age, severity of symptoms, other underlying medical conditions, and potential for adverse drug side effects. Intravenous drug therapy may be needed for more serious infections. The following antibiotics may be used to treat community-acquired MRSA skin infections.

Trimethoprim/Sulfamethoxazole

• Available as oral (by mouth) and intravenous preparations
• May be taken with water or on an empty stomach
• If using a suspension, shake well before using
• Common side effects may include nausea or rash (If your child develops a rash with this medication, you should tell your doctor immediately)
• May be used in combination with another antibiotic if the doctor thinks the infection may be from another type of bacteria. 

Clindamycin

• Available oral and intravenous
• May be taken with or without food
• Capsule should be taken with a full glass of water; suspensions should be shaken well before use
• Children often complain of bad taste
• Commonly associated with diarrhea as a side effect

Doxycycline

• Available oral and intravenous
• Not for children < 8 years of age
• May be taken with food
• Capsule should be taken with a full glass of water; suspensions should be shaken well before use
• Avoid antacids, infant formula, milk, dairy products and iron for 1 hour before or 2 hours after your child takes doxycycline
• May cause upset stomach

Vancomycin

• Available intravenous only
• Used for moderate-severe infections
• Common side effects include rash, flushing of face or neck

Linezolid

• Available oral and intravenous
• Very expensive; may not be covered by some insurance plans
• May be taken with or without food
• Gently invert suspension bottle 3-5 times before use
• May cause nausea, diarrhea, or headache

Things to remember about antibiotics:

• Take all of the doses that your doctor prescribes, even if the infection improves
• Never share antibiotics with others
• Notify your doctor if infection does not seem to get better, or if symptoms worsen

Topical treatment

• Your doctor may also prescribe topical treatment along with antibiotics because MRSA can live on the skin

Mupirocin 2% ointment

• Your doctor may instruct you to apply the ointment to the wound or inside the nostrils because Staphylococcus aureus usually is found in the nostrils
• It is important to wash your hands before and after applying the ointment
• The ointment should not be applied to the eyes

Povidone-iodine, triclosan, or chlorhexidine gluconate body wash

• Your doctor may instruct you to bathe/shower with one of these medications
• Apply body wash to wet body and/or hair and rinse with water
• Do not irritate the wound while bathing
• The body wash should not be swallowed and if it gets in the eyes, rinse the eyes immediately with water
• This body wash should only be used during the length of treatment and is not a substitute for everyday soap/body wash

How does one avoid getting or spreading MRSA infections?

Maintain good personal hygiene

• Wash your hands often with soap and water or use hand sanitizers. More importantly, wash your hands after touching wounds or bandages
• Do not share personal items such as towels, toothbrushes, bar soaps, razors, or sports equipment with others
• Children should shower/bathe after participating in athletic activities
• If MRSA skin infections are recurrent, bathing in a bleach bath (1 teaspoon of bleach per gallon of water or ¼ cup in ¼ full bathtub) twice a week may be helpful, but you should ask your doctor before beginning this regimen

Properly care for wounds

• If wounds become red, swollen, warm, or painful, contact your doctor immediately
• Keep wounds clean and dry and covered with a bandage if there is drainage
• Change bandages often and always use new bandages. Be sure to throw away used bandages and wash your hands after handling bandages
• Avoid touching other people's wounds or bandages
• Always follow your doctor's instructions on how to take care of your wound

Do laundry and clean up

• If your child gets an MRSA infection, it is important to clean all linens and clothes he/she uses. Wash clothes, bedding, and towels using hot water, laundry detergent, and bleach if it is possible
• Disinfect your house by cleaning areas or items that are used often such as bathrooms, kitchens, telephones, TV remotes, and doorknobs. Using diluted bleach or other cleaning products is recommended

Can my child attend school with MRSA skin infection?

• Infected children do not need to stay home from school if their infection was properly treated. Some schools may require children to stay home for at least 24 hours after starting antibiotics
• If your child returns to school or athletic activity with a bandaged wound, advise him/her to keep it covered and avoid touching it
• Children may be excluded from school or other activities if they have wound drainage that cannot be covered with a bandage

Things to remember:

• Draining wounds should be kept covered
• Follow your doctor's recommendations for wound care
• Always wash hands and use gloves to care for your child's infection
• Avoid contact activities until the wound has completely healed

Notify your doctor if infection does not seem to resolve, or if symptoms worsen.

References

Cohen PR. The skin in the gym: a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes. Clinics in Dermatology 26:1 (2008), 16-26.

Klevens RM, Morrison MA, Nadle J, et al. Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States. JAMA 298:15 (2007 Oct); 1763-1771.

Kaplan, SL. Evaluation and management of suspected methicillin-resistant Staphylococcus aureus skin and soft tissue infections in children. In: UpTo Date, Torchio, MM (Ed), UpToDate, Waltham, MA, 2010.

Stevens, DL, Bisno, AL, Chamber, HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections. Clin Infect Dis 2005;41:1174-8.

"Information for schools/parents/students on community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA).” American Academy of Pediatrics. Available at URL:  http://www.aap.org/NEW/MRSA.HTM. Accessed March 23, 2011.