By: James A. Wilde, MD, FAAP
Methicillin-resistant Staph aureus (MRSA) is a staph bacteria that is resistant to certain antibiotics and is one of the leading causes of skin infections in the U.S., both in children and in adults.
While MRSA was once limited to hospitals and nursing homes, over the past 15 years it has spread all over the world―into the community in schools, households, and child care centers, among other places.
According to some surveys, up to 30% of children in U.S. classrooms have MRSA on their skin or in their noses. A child's first line of defense against MRSA is a well-informed parent. Read on.
Here are frequently asked questions about this "super bug" from other parents like you:
How do children get MRSA?
- MRSA spreads with skin-to-skin contact, or by touching objects or surfaces that are contaminated with the bacteria. Once it spreads to a child, they can either become a carrier for the bacteria or develop an active
Most children who are carriers for MRSA don't develop any symptoms of infection. The bacteria simply live on their skin or in their noses. But they may pick at their noses, for example, and spread the bacteria to toys they play with. Older children who play sports can also spread MRSA bacteria through shared equipment.
For an active MRSA infection to take hold, there must be an opening in the skin or in the nose for the bacteria to get into the body. This can come from minor cuts and minor scrapes, scratching at a bug bite, conditions like
eczema, or even
body piercings. Once the skin is open, even a tiny amount, MRSA bacteria can get in and start to multiply.
What are the signs and symptoms of a MRSA infection?
- It usually starts as a bump or infected area on the skin that appears red or swollen, has pus, is warm to the touch, or just looks infected. If you or someone in your family experiences these signs and symptoms, cover the area with a bandage and contact your doctor. It is especially important to call your doctor when these signs and symptoms are accompanied by a fever.
View photos of MRSA skin infections here.
The most common skin infections caused by MRSA include
abscesses, boils and cellulitis. They often are mistaken for spider bites, or may resemble a pimple, blister or rash. In rare cases, MRSA can also lead to more serious infections inside the body like
pneumonia, bone infections,
If my child was exposed to MRSA what should I do?
- If your child is exposed to another person with MRSA infection, the chances he or she will develop an infection is very low. If you notice any concerning symptoms mentioned above, call your pediatrician.
How is MRSA different from other Staph infections?
- Here is a little background on that: Staphylococcus aureus or
"staph" infections used to be easy to kill with penicillin. In the late 1940s and throughout the 1950s,
things changed; the bacteria adapted and penicillin wasn't able to treat the infection. Scientists created new forms of penicillin, including methicillin, to counter the problem.
For many years, methicillin and other engineered forms of penicillin effectively treated for Staph aureus infections. But because healthcare providers
prescribed antibiotics too often, Staph aureus was able to change again around the year 2000 and become resistant to methicillin. The name given to this new germ―MRSA.
Can MRSA be treated?
- Yes. When treated early, MRSA skin infections usually get better. Although penicillin and methicillin no longer work to kill MRSA, there are other antibiotics that do work and can be used in children. And sometimes antibiotics aren't needed at all. Treatment options include:
If the collection of pus is an inch or two in diameter, your doctor can make a small cut or incision in the skin and squeeze the pus out. Nature usually handles the rest without antibiotics.
Children infected with boils, abscesses, or cellulitis can have a culture taken by their doctor to determine the best antibiotic choice.
If the abscess is very small, sometimes antibiotics can treat the infection without the need for an incision.
Very large abscesses, especially if there is also fever, need to be drained. Then the doctor prescribes one of the antibiotics that kills MRSA. This can sometimes be done as an outpatient procedure at the hospital, but young children often require a short admission to the hospital.
Why do hospital staff and visitors have to wear gloves and gowns in the room of someone with MRSA?
- Gowns and gloves are worn in the hospital to prevent the spread of MRSA to other patients; sick people are at higher risk of infection from MRSA. To avoid the infection from spreading once your child is home from the hospital, make sure to cover your child's sore (if present) with clean, dry dressings or bandages as directed by your doctor. Any used bandages and dressings can be thrown into the regular trash. If these items are soaked with wound drainage or other body fluids, place in a plastic bag and seal, then throw into regular trash. Be sure to wash your hands well with soap and water or alcohol gel after handling these items.
Can I visit someone in the hospital with MRSA while I'm pregnant?
- Although more research is needed on MRSA and pregnancy, there is currently no evidence that that Staphylococcus aureus exposure increases complications like miscarriages or birth defects. In fact, one
study found babies born to mothers who carried MRSA on their skin rarely became sick from the bacteria. Pregnancy does weaken your immune system some, however, so it is important to be extra careful when you are near someone with an active infection.
If you visit someone in the hospital when you are pregnant, always wash your hands afterward and wear a mask and gloves. It's a good idea to wash your clothes in the hottest temperature water recommended once you get home, too. If you do get a MRSA infection during pregnancy, it can be treated.
Is it safe for a grandmother with MRSA living in her nose to hold her grandchildren?
- Yes. The risk of transmitting MRSA to them is small. It is possible to spread MRSA by touching your nose and then touching someone else. Washing your hands with soap and water or alcohol gel after touching your nose and before touching others will help to prevent the spread of MRSA to others.
Should my child stay home from school if she has MRSA?
- Those who only carry MRSA in the nose or on their skin but who do not have signs or symptoms of infection are able to go to school and other activities. Those with active MRSA skin infections may also be at school IF:
The infection can be covered with a bandage or dressing.
All wound drainage can be contained throughout the day without having to change the dressing or bandage at work or school.
The infected person is willing and able to follow good hand and personal hygiene.
Until skin infections are healed, children with MRSA skin infections should not use whirlpools or swimming pools or participate in contact sports or other physical activity in which bandages or dressings may fall off.
If someone gets MRSA, will they always have it?
- Maybe. Many people who have active infections are treated and no longer have MRSA. However, sometimes MRSA goes away after treatment and comes back several times. If MRSA infections keep coming back again and again, your doctor can give you advice on how to stop these repeat infections or spread of the infection to other family members.
Even if active infections go away, you can still have MRSA bacteria on your skin and in your nose. This means you are now a carrier of MRSA. You may not get sick or have any more skin infections, but you can spread MRSA to others. It is not fully understood why some people are carriers of MRSA, yet don't get infections.
If your child has MRSA, teach him or her what it means to have a contagious infection. Make a plan with your child care provider to reduce the risk of spreading MRSA to other children. If your child is in school, make a plan with the school nurse.
About Dr. Wilde:
James A. Wilde, MD, FAAP, is board-certified in pediatrics, pediatric infectious diseases, and pediatric emergency medicine. He is a Professor of Emergency Medicine and Pediatrics at the Children's Hospital of Georgia, Augusta University. Within the American Academy of Pediatrics, Dr. Wilde is a member of Section on Infectious Diseases and the Georgia chapter.