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The Answer Doc
MRSA A bad bug but not as bad as you think
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    Recently, both in the office and on my blog, I have received questions about a certain type of bacterial infection called MRSA, or methicillin resistant staph aureus.  MRSA has been in the new quite a bit recently. The was a high school in Virginia that was closed and scrubbed down because several students had become ill and one had died secondary to infection caused by this bacteria. I wanted to take time to explain what MRSA is, why it is dangerous, and why the good people of Bulloch county should not be as worried about MRSA as the folks in Virginia.
What is MRSA?
    Staph aureus is a bacteria that lives in the nose and on the skin of about 33% of all Americans.  These people are “colonized” with the bacteria and it causes them no harm. Staph aureus can be spread by skin to skin contact and by nasal secretions coming into contact with skin.  For many years, the main treatment for staph aureus was using antibiotics from the penicillin family and those closely related to the penicillins.  MRSA got its name when a strain of staph aureus became immune to methicillin, which is the standanrd used for testing if a bacteria can be killed by a penicillin-type drug.  There are two major types of MRSA, hospital acquired and community acquired. We are going to focus on community-acquired MRSA.
How MRSA infections start, what can happen?
    Staph aureus can cause an infection when it enters the skin through some forms of wound which can include, cuts, scrapes, insect bites, and chronic ulcers.  Most of the time, the bacteria causes a local skin infection, called cellulitis, and often causes abscess formation, which are commonly called “boils” or “risings.”  However, in some cases the bacteria can burrow deep into the skin and can result in infections of joints, infection of the blood stream, and infection of heart valves through spread in the blood.  These more serious staph aureus infection usually occur young children, whose immune systems aren’t fully developed, and in people that have other chronic medical problems which can lead to weakened immune systems. Examples include those with poorly controlled diabetes, people on dialysis, people living with HIV/AIDS, and cancer patients.
Who is most at risk
for MRSA infections?
    ‰ 1. Children:  For reasons mentioned above and because they are in close contact with other children at school and daycare. They are likely to come into skin to skin contact with other kids that may have scrapes or runny noses.
    ‰ 2. Those that participate in contact sports.
    ‰ 3. People with weakened immune systems or chronic illness.
    ‰ 4. Those that may have been recently incarcerated due to close quarters.
    ‰ 5. People that recently went through military basic training secondary to close quarters.
    ‰ 6. Assosciation with health care workers. Many health care workers are likely to be colonized with MRSA.
What can I do
to protect myself?
    ‰ 1. Wash your hands. Hand washing is the single best preventative against any infection.
    ‰ 2. Keep wounds covered. If you have a scrape or cut, please keep it bandaged, especially if you play sports or go to a gym.
    ‰ 3. Don’t share personal items.  If you go to gym or play sports, don’t share razors, towels, or athletic equipment.
    ‰ 4. Make sure to sanitize linens.  If someone in your home has a cut or scrape, wash their sheets and towels daily in hot water and dry on hot.  Also, wash gym clothes and athletic apparel after each use.
    ‰ 5. Be proactive: If you have a suspicious skin infection, see your doctor. You may need the infection to be tested for MRSA.
    Finally, I wanted to put some minds at ease.  MRSA, like any bacteria, has different patterns of resistance to antibiotics based on the geographic region in which it is found.  Unfortunately, for the people in Virginia, the type of MRSA in that area is not susceptible to any common oral antibiotics, and anyone with a significant MRSA infection would have to be hospitalized.         The type of MRSA found in Bulloch County is very sensitive to Bactrim, which is an inexpensive (generic), sulfa-based drug.  For people that are allergic to sulfa, there is another oral antibiotic called linezolid, which can be very expensive, that very effective at killing this bug.  If you have an abscess that needs to be drained, make sure your doctor gets a culture to check if the infection is caused by MRSA. He or she may want to cover you for MRSA from the get-go.
    The bottom line is that right now for people in relatively good health, being diagnosed with MRSA in Bulloch county does not mean automatic hospitalization.  For people that are more at risk for serious complications from an MRSA infection due to other health problems, they can rest assured that even if they need to be in the hospital, the strain of MRSA that we have is still sensitive to a number of IV antibiotics.
    MRSA is a nasty bacteria, no doubt, but if an infection is identified in a timely fashion as being caused by MRSA and treated appropriately, the vast majority of patients will have a full recovery.

    Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board-certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelors degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.
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