MRSA infects 94,000 Americans a year, and the superbug is no longer confined to hospitals. Here's what you need to know to protect yourself and your kids.copyright Jessica Snyder Sachs, as first appeared in BEST LIFE magazine
It started one morning last June, when 14-year-old Max Yardley felt a little tenderness in his elbow. The arm looked fine, so Max's dad, Rockie, an explosives specialist with the Edmond, Oklahoma, police department, figured the problem was soreness left over from the lifeguard training Max had just completed. But that night, Max woke up his parents at 3 a.m. The pain had become excruciating.
"This is a kid who doesn't normally complain," says Yardley. "He'd been sick all of five days in his life." The Yardleys raced to the emergency room. Over the next 24 hours, Max's temperature soared to triple digits and his blood pressure plummeted. When doctors ran the usual laboratory tests, it came back positive for methicillin-resistant Staphylococcus aureus, or MRSA. A bacterial infection had infected the bone of Max's upper arm and was racing through his body, shredding up his lungs, liver, and spleen.
"One morning we had a perfectly healthy boy. Twenty-four hours later, the doctors were struggling to keep him alive long enough for the antibiotics to start working," recalls Yardley, who, as a former paramedic, understood enough about his son's vital signs to call the family's priest.
Unknown just 15 years ago, community MRSA (hospital MRSA's virulent sister) now accounts for more than half the serious staph infections showing up in the nation's emergency rooms. Some children's hospitals see it in more than 75 percent of the staph-infected children they treat.
"Once it arrives in a community, it just seems to take over," says Sheldon Kaplan, MD, chief of infectious diseases at Texas Children's Hospital, in Houston. Pediatric specialists fear that the superbug, which already accounts for 19,000 deaths in the United States each year, could soon become commonplace across the country. The vast majority of community MRSA cases are skin and soft-tissue infections, Dr. Kaplan explains.
But around 5 percent involve potentially deadly pneumonias and internal infections such as Max's. When this bug enters the bloodstream, it can cause severe and sometimes fatal disease, and many of those who survive bloodstream infections sustain severe organ damage, require limb amputation, or both. "A child's growing bones remain particularly vulnerable," says Dr. Kaplan, "because they are open to bacteria circulating in the bloodstream."
Max was one of the lucky ones. After a week on a respirator, he emerged without permanent organ damage. After another two weeks on intravenous antibiotics, he finally went home to complete his recovery and was symptom free after another seven weeks on antibiotics.
Each year, more and more kids aren't so fortunate. MRSA deaths among previously healthy kids began cropping up in the 1990s. "At first we assumed these children had some connection to a health-care setting in which MRSA infections had been confined," explains epidemiologist Jeffrey Hageman, a MRSA expert with the Centers for Disease Control and Prevention, "but it eventually became clear that something else was going on." Antibiotic use outside of hospitals may have bred strains of MRSA distinct from those in medical centers.
And although community MRSA isn't resistant to as many kinds of antibiotics as is hospital MRSA, what it lacks in multidrug resistance it appears to make up for in virulence. Medical experts are just working out how staph in general, and MRSA in particular, wreaks its damage. But new studies suggest that community MRSA strains have the ability to kill the kinds of immune cells that would normally eliminate such microbial invaders. This stubborn persistence, in turn, tends to trigger septic shock, a kind of immune-system meltdown in which body-wide inflammation leads to organ failure, massive blood clotting, and plummeting blood pressure.
Community MRSA has an aggressive tendency to enter through even the smallest of cuts and abrasions. For this reason, it often spreads in locker rooms and gyms, and between members of sports and dance teams, who have frequent skin contact with both other participants' skin and shared surfaces such as athletic equipment and benches, explains Hageman.
Ineed, if you have a child in school or day care, chances are you've received some version of the panic-but-don't-panic note, as in "Dear parents: A confirmed case of MRSA infection has been brought to our attention. Please be assured we are taking appropriate measures." Some schools go so far as to shut their doors for a massive, one-time disinfection--a move that may be as ineffectual as it is overdramatic.
A less overblown but diligent effort is key, say health experts. "Perhaps one of the biggest problems for parents, dads in particular, is deciding when to give your kid Tylenol and send him to bed and when to go straight to the emergency room," says Yardley. "For me, it was the urgency of Max's complaints that raised the red flag."
Here's what you need to know to protect your children from community MRSA:
1. Know When Risk is Greatest
Studies show some of the highest rates of MRSA in groups such as team athletes and those who have had a medical procedure or taken antibiotics within the past year. MRSA is what doctors call an "opportunistic pathogen," a microbe that takes advantage of breaches in the body's defenses. Young children are particularly susceptible because their immune systems aren't yet fully developed. "Staph. aureus can't be eradicated," explains MRSA expert Jeffrey Hageman, of the Centers for Disease Control and Prevention. "Overall, around one in a hundred Americans carries a resistant strain of this bug."
2. Avoid Unnecessary Antibiotics
MRSA infection rates are up to eight times higher among those who've taken antibiotics in the previous year. By eliminating the drug-susceptible competition, antibiotics promote the success of any microbe that can shrug off their effects. "Antibiotics tend to replace your body's protective bacteria with drug-resistant troublemakers," explains Tufts University's Stuart Levy, MD, author of The Antibiotic Paradox. When antibiotics are necessary, ask your doctor for the "narrowest spectrum" (most specifically targeted) antibiotics, which tend to be less disruptive of the body's good bacteria than are "broad spectrum" (big gun) antibiotics.
3. Wash Away the Bugs
"Teaching children good hygiene is the single most important thing you can do to protect them," says Hageman. Staph spreads primarily through skin-to-skin contact and frequently touched surfaces. Experts recommend frequent hand-washing with ordinary soap and water or, when that's not convenient, an alcohol-based hand gel. "Staph takes several hours to infect an abrasion," says Hageman, "so there's a window of time when it can be washed from the skin."
Drug-resistance experts such as Levy advise against using antibacterial soaps containing chemicals such as triclocarban and triclosan. They act like antibiotics and, in laboratory tests, promote the rise of drug-resistant bacteria.
4. Keep Exercise Areas Clean Encourage young athletes--or their coaches--to wipe down mats and sporting equipment with soap and water or bleach wipes between uses. Children can also use a personal towel or other barrier between their skin and shared exercise surfaces and equipment. Insist on daily disinfection of locker rooms and weight-room benches, wrestling mats, and other shared athletic equipment as well as the mats used by younger children for napping. The Environmental Protection Agency maintains a list of safe and effective MRSA disinfectants.
5. When in Doubt, Check It Out
MRSA infections don't always look scary. The skin may become red, swollen, and tender. An infected joint, bone, or muscle may look normal but feel painful. Sometimes symptoms include fever, nausea, or weakness, says Sheldon Kaplan, MD, of Texas Children's Hospital. That can make MRSA infection difficult to distinguish from muscle sprains or the flu.
6. Get a Flu Shot
When MRSA and the flu end up in the same body, the result can be life-threatening. "It's the perfect storm," says John Francis, MD, an infectious disease consultant at Yale University School of Medicine. Getting an annual flu shot may help protect against this deadly combination.
Jessica Snyder Sachs is the author of Good Germs, Bad Germs, out in paperback this fall.
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