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I work at a center for women and children who are victims of domestic abuse. Yesterday a little girl came in with her mother who had a bite mark on her hand. It was red and ugly so they sent her to the emergency room. Turns out she has MRSA. I thought that was something you got from being in the hospital. How did this little girl get it?
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If you are working with children, it's likely that you have heard of (or seen) "staph infections" referring to infections caused by the bacteria known as staphylococcus aurous. In recent years, this bacterium has become resistant to antibiotics traditionally used to treat the problem. And the number of cases in children has risen at the same time. Studies are underway to identify how often and why this is happening among children and young teens with skin and soft tissue infections.
The term Methicillin-resistant Staphylococcus aureus (MRSA) has been adopted to indicate the bacteria is resistant to a number of antibiotics including penicillin, methicillin, and cephalosporins. The bacteria have mutated (changed) so they are no longer able to be damaged or disabled by these previously effective medications.
MRSA is very powerful and can cause a large number of serious illnesses that do not respond well to current medical treatment. As you pointed out, MRSA was always hospital-acquired -- in other words patients developed MRSA infections when they went to the hospital to be treated for something else. But over time, community-acquired MRSA (known as CA-MRSA) developed. CA-MRSA is defined as MRSA that occurs outside the hospital setting.
A recent hospital-based study was done to see how many children are affected by CA-MRSA and why? In this study, the researchers reviewed their records for 10 years (2001-2010) and pulled the medical charts of any patient 0 to 14 years old who presented with hand infections at their hospital.
By studying the information about each case, they were able to see some patterns that might be helpful in better understanding CA-MRSA in children. Overall incidence of CA-MRSA in the group was 25 per cent. That means one in every four children admitted to the hospital for a skin infection already had CA-MRSA before even coming to the hospital. This is much higher than the recommended rate of no higher than 10 to 15 per cent set by the Centers for Disease Control and Prevention (CDC).
By analyzing the children's charts, they were able to identify risk factors -- variables that put the children at increased risk for developing CA-MRSA. Instead of the typical risk factors reported for adults (e.g., older age, poor health, abscess drainage in a surgical setting, history of trauma, previous history or MRSA), they found children had a different set of risk factors.
For the children in this study, low income living conditions, poor personal hygiene, and crowded settings with close personal contact were the main risk factors. The presence of an abscess that needed surgical draining was an additional risk factor. The deeper the abscess, the greater the chances the child had a positive case of CA-MRSA. Any one of these risk factors or a combination of them could explain why the little girl in your care developed this problem.
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