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Community- Acquired MRSA.

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Greetings Doctor,

My wife, 27, had a community-acuired MRSA episodes in the recent past. We're going to do everything possible to ensure her skin infections are cured for good and she only remains colonized. She gets terrified at every cuts and bruises she gets thinking that her MRSA will enter into her bloodstream. We're very scared and confused from reading a lots of information online. We're also planning to have our first baby in 2 years and we're not sure if she is able to give a borth to a healthy child and keep the child from getting infected with MRSA from her. Thank you!


Category: Infectious Disease Specialist

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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.



Hello,

Thank you for choosing DoctorSpring.

I understand your concern and will try my best to help you out here.
1.Can you please clarify about the MRSA 'episodes'?
2.Was there multiple episodes of MRSA infection ?
3.Was it a skin wound ? How did it happen ?
4.What kind of antibiotics she has taken?
5.Is the wound healed now ?
6. Is she otherwise healthy ? Any chronic medical conditions ?

You can reply as a followup
Thank you


Patient replied :

Hello Doctor, please see my responses below:

1.Can you please clarify about the MRSA 'episodes'?
> IT started about 8 months ago. The firs time, she had a small boil in her left leg around Knee area which healed after a few days. A couple of months later, she had a big boil on her butt which was painful and it drained after a few days. Up until now, we didn't know it was MRSA causing these infections. Third episode started in mid december 2013 where she has a few pus-filled pimples and a boil in her groin area. The boil turned into a painful wound. Doctor in ER prescribed Sulfamethoxazole and Sephalexin and then also took culture of the wound for lab testing. The report came back as MRSA. I've attached the culture report with this response for your review. She doesn't work in a medical facility or has had any surgery so she must have picked up in the community. The forth and episode started in early March in the form of 3 successive puss-filled pimples that popped up one after the other on her lips. Doctor prescribed Sulfameth/Trimethoprim to which she had an allergic reaction (red skin) so we stopped after a day. We put Manuka Honey on the pimple and it healed after 3 days. I don't think any doctor in ER so far has seen the culture report before prescribing antibiotics. Can you tell from the culture report what type of MRSA she has?

2.Was there multiple episodes of MRSA infection ?
> Yes, 4 in last 8 months.

3.Was it a skin wound ? How did it happen ?
> I don't think she had any open wound that started all this. Really not sure.

4.What kind of antibiotics she has taken?
> Listed in answer#1.

5.Is the wound healed now ?
Yes. Does she have to worry at every cut and bruise now that she has MRSA?

6. Is she otherwise healthy ? Any chronic medical conditions ?
> Yes, she's otherwise healthy and no chronic conditions.

This has caused us both a great deal of sadness. Hope to get your reply soon. Thank you again!

Sincerely,
P. Patel


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,

Thank you for providing the additional information.

There is no reason to worry. MRSA infections can be treated and eliminated. This does appear to be a community acquired infection. (It is not possible to identify from the records though). sulfamethoxazole and trimethoprim is a good oral antibiotic for MRSA ( I assume it was not sulfamethoxazole alone, rather was a combination with trimethoprim). Most likely this antibiotic has eliminated the infection from your body.

The definitive way of to know whether MRSA was totally eliminated from your body is by doing some tests for carrier state. This will involve culture from the nose (nasal swab) and from body surface like axilla or groin. But in your case this is not recommend as there are no new active lesions or evidence of carrier state. However I want you to be aware of this option. You can discuss with your GP about this.

In any case there is colonisation of MRSA it can be managed with some measure like nasal antibiotics and chlorhexidine baths. The past infection with MRSA is not a risk factor for a healthy pregnancy and it will not harm you baby in future. However you should disclose this history of MRSA to your OBGYN. U

So as of now, no active intervention is needed. In case if there is another infection or wound you need to do a repeat culture. If its is MRSA positive you need to go for a carrier screening (for all family members).

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Hello Doctor,

Thank you so much for your reply. Today we went to an Infectious Decease Doctor here in NYC and he prescribed Hibiclens bath for my wife for 3 months and nasal cream for two weeks. After that, he suggested Hibiclens once a week. He didn't suggest anything for me even though I am likely to be colonized. He also told us to not worry as MRSA is not uncommon.

If I can tell you from my heart, we are truly devastated, sad, depressed. We have an active social life and we also frequently visit our parents and families. Although we are going to keep ourselves extremely clean, exercise regularly, good diet etc., we feel that we are somehow an outcast as we are truly afraid to touch anyone; visit anyone; invite relatives to stay with us; hug our loved ones; and our future plan to have babies. It seems that our life is over from what I've been reading on the Web which sounds like we aren't supposed to touch anyone, anything, take multiple baths, keep everything clean, do laundry daily of bedding sheets, towels etc. and do it separate from other people's clothes in the family, and disinfect every day...many aren't possible to abide by at all times in real life. We don't know what is reasonable and what's not. We are completely confused and sad. I pray to God that there will be a complete cure from MRSA some day, hopefully soon. Is that a reasonable expectation from your point of view and from what you might know about the current state of medical research?

Please feel free if you have any other advise or resources we can use for help. Again, Thank you for being generous and taking time to reply.

Regards,
P. Patel


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello Mr.Patel,

I think you are bit misinformed about MRSA infection (the pointless online resources are to blame). What your wife had is a non invasive community acquired MRSA which commonly affect 'healthy young people'. This is a lot different from invasive MRSA or hospital acquired MRSA.

This is just 'chance' as in you can catch a cold/flu virus by chance. As I said the antibiotic itself might have eliminated the bacteria. Your Doctor has suggested the best MRSA preventive strategy. Within 5 days of using the Chlorhexidine soap and Mupirocin your wife will be free of MRSA (in case if she is still infected).

You and your wife can continue life as usual as there is no evidence of active infection or carrier state. You can also get tested for a carrier state by a swab test. But this is not really necessary, but if you have an option go for it as it will give you peace of mind.

MRSA is not a monster bug or something. There are the same Staph bacteria which are found in plenty in the environment. Just that many antibiotic won't work on them. So you need to choose the therapy specifically.

Honestly I am sure that this is something that can be contained and treated.

Hope this helps
Feel free to ask followups / clarification.


Patient replied :

Hello Doctor,

Today, 3 new spots filled with Puss popped up on my wife's skin in and around the buttocks area.

Regards,
P. Patel


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

Hello Mr. Patil,

The pus need to be let out for a culture and sensitivity. Bases on the result antibiotic can be considered. Clindamycin is a preferred choice. General isolation is recommended.

Lets see how the culture turns out to be.

Thank you


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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