Precautions for MRSA

I had a clinic appointment yesterday in which I found out that in my last sputum sample, I cultured MRSA. This was a HUGE blow as MRSA in one of my biggest fears. I've also gone almost a year without a hospitalization (normally I'm doing at least twice a year visits) because I've been extremely compliant and my PFTs had been steadily increasing, so it was kind of a shock to hear that I got it, but not from the hospital. I did a quick CL search on MRSA and came across a question you responded to, and noticed that you have cultured MRSA yourself. Reading that was very calming, as it tells me that you can be healthy even if you have it.

I was hoping that you could answer a few questions based on your experience. You've mentioned before that your doctors said you didn't have to worry about avoiding babies or older individuals- is that true for brand newborns? Did you have to (or choose to) take any extra precautions when Mckenna was born? This is a major worry of mine because my cousins are all having babies that I would like to be able to hold and play with. I also hope to be able to try having children in the somewhat near future, and, although the situation is a tad different considering I would be the one carrying the pregnancy, it would be comforting to hear from a CF parent with MRSA about their experience. Another major concern that I have is that my brother Brian, who also has CF, doesn't have MRSA. I asked my doctor about precautions, as I will be seeing him at Christmas, and he said that we should avoid hugging, but that mask wearing isn't as crucial. Do you have any suggestions there? As much as it's difficult for me to accept that I can't hug my brother the few times I get to see him, I plan to do follow his suggestion, and I have considered wearing a mask anyway, just to be safe.

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Culturing anything new is never what we want to hear, but as you've seen me say already - not the end of the world. Of course everyone reacts differently to various bacterias, but I've been told that many US doctors don't believe that MRSA is a huge deal nor has a major impact on the lungs. They feel differently in Europe, but that's neither here nor there.

My lung function started to decline before I contracted MRSA due to "being responsible for my own health" and making poor decisions. I've had MRSA for about 10 years now, but through better adherence and an increase in treatments and exercise, I've been able to increase my lung function back to where it was 10 years ago. It's hard to know if MRSA has had any impact whether it be on lung function or "recovery time".

To answer your questions....
1. I asked as many doctors as I could and they all said the same thing - I did not have to worry about being around my newborn daughter. They said the only people that I would have to take precaution around would be those with no immune system (ie, chemo patients).
2. We did not take any special precautions with Mckenna.
3. A mask would only be useful if you are actively coughing. Otherwise, no contact and not coughing/talking in his direction should be enough.

I wouldn't worry a whole lot about it. Just continue kicking butt by taking care of yourself and discuss with your brother what would make him the most comfortable.

Question by Reader: MRSA

Got this question a few weeks back and I figured that many of you could relate:

Question: My son is 17 months old and swabbed for mrsa at his 15 month visit. We did 6 weeks of bacterum, 2 wks of rifampin, a body wash and nasal cream and his mrsa did not go away. We are especially clean and practice great handwashing. I'm blessed to be a stay at home mother so I have the extra time to be extra clean. I know some things are obviously out of my hands though. Anyway, he hasn't had ANY lung issues in life. I'm very nervous about the mrsa and the nurses and doctors just kind of say they don't know if it is bad or not and not to worry because he's healthy right now. If you know any solid information on mrsa and the fact that he's never had any symptoms but obviously carries it, please let me know. You don't have to sugar coat or hold anything back. I just am not sure what lies ahead, but I suppose we never are sure. I will appreciate any info or advice you have. Also, the doctors said they will not try to get rid of the mrsa again. They say they give it one good shot and then leave it alone. Do you think this is a good idea or should I push for something else?

So what do I know about MRSA? I've had it since about 2004. My lung function is just as high now as it was then. I have had increased hospitalizations, but that could be a result of age and a variety of other factors. I must also note that my hospital stays have shortened since recommitting to treatments and exercise - 3/4 treatments a day plus 1 hour of exercise.

Most doctors in the US only aggressively treat MRSA if symptoms are present. I say US doctors as doctors in Europe are more concerned with MRSA then they are pseudomonas. Our doctors here on the other had aggressively treat pseudo and not MRSA. I'm guessing the difference has to do with the interpretation of different studies.

Anyway, my doctors took the same approach. They aggressively treated it at first, but as it continued to show up, they backed off. My recommendation would be to aggressively treat it for a couple more rounds and see what happens. Chances are that it is here to stay, but you never know. I think regret will always come with not treating something rather then treating it and it still being there. Does that make sense?

Like I said however, what's most important is how he is feeling. Now, at 17 months old, that may be a bit tough to tell, but be sure to pay attention to his symptoms. 

I'm a bit surprised that they don't have you doing any nebs. If anything, it could get him used to what is to come. CPT may be more effective if it is preceded by some albuterol to open him up. With that said however, it may not be needed.

SO HAPPY to hear that thus far there doesn't seem to be much lung involvement! 

It sounds to me like you are doing a fantastic job with your son's care. Don't stress out about these various bugs. Some will happen, some will not. It is not a reflection on how "clean" you guys are or whether or not you wash your hands 100 times a day.

Coffee and Tea Drinkers Less Likely to Carry MRSA

Original post can be found on Medpagetoday.com

People who drink hot tea or coffee are less likely to carry methicillin-resistant Staphylococcus aureus (MRSA) in their noses, researchers found.

Drinking either beverage was associated with about a 50% relative reduction in the odds of nasal MRSA carriage, and drinking both was associated with a 67% reduction, according to Eric Matheson, MD, of the Medical University of South Carolina in Charleston, and colleagues.

The findings, reported in the July/August issue of Annals of Family Medicine, "raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible," they wrote.

The clinical importance of the finding is not entirely clear, however, as the relationship between nasal MRSA carriage and the chances of systemic infection has not been resolved, they added.

Previous studies have shown that tea and coffee have antimicrobial properties when applied topically, and to find out whether drinking the beverages had systemic effects the researchers turned to the 2003-2004 National Health and Nutrition Examination Survey (NHANES).

The analysis included 5,555 individuals ages 2 and older, representing 182.1 million people. About half (48.6%) reported consuming hot tea over the past month and 60.8% reported drinking coffee over the past month.

Overall, 1.4% of the participants carried MRSA in their noses.

After adjustment for age, race, sex, poverty status, current health status, hospitalization in the past 12 months, and use of antibiotics in the past month, there were lower odds of nasal MRSA carriage among individuals who drank any amount of hot tea (OR 0.47, 95% CI 0.31 to 0.71), coffee (OR 0.47, 95% CI 0.24 to 0.93), or both (OR 0.33, 95% CI 0.16 to 0.70), compared with those who drank none.

A separate analysis of just the adult participants provided similar results.

Consumption of iced tea, however, was not associated with nasal MRSA carriage. The reason is unclear, but it could be that iced tea has lower levels of polyphenolic compounds than hot tea, or that the volatile antimicrobial compounds in coffee and tea reach the nose in vapor form, according to the researchers.

Although the study -- cross-sectional in design -- could not establish a causal relationship between drinking coffee and tea and nasal MRSA carriage, there are some possible mechanisms to explain the finding.

"In the case of coffee, particular attention has focused on the potential antibacterial properties of trigonelline, glyoxal, methylglyoxal, and diacetyl," Matheson and colleagues wrote. "For tea, attention has focused on the antimicrobial properties of tannic acid and catechins."

In addition, they wrote, drinking both coffee and tea decrease iron absorption, which could affect the growth of S. aureus.

The authors acknowledged that the study was limited by the exclusion of some individuals because of missing data and the inability to determine when the participants last drank coffee or tea.

They noted that the study could not address the larger question of whether nasal MRSA carriage is associated with systemic infection.

"Given this debate, the benefits of any treatment for MRSA nasal carriage should be carefully balanced against the risk," they wrote.

Original article here

MRSA and Cystic Fibrosis continued...

Last week I posted an exchange between myself and a fellow community member regarding her child and MRSA (which can be found here). Many of you were very interested in the post and requested that I share stuff like that more often. The community member and I continued our conversation a bit so I thought I'd share with you the rest of what we discussed. Hopefully you find it useful and/or interesting.

About the MRSA. I am still confused. The nurses, RT, pharmacist and Dr all told us that lots of people carry the bacteria and dont even realize it. If it wasnt that our son had CF we wouldnt know he had it either. If it were any of our others kids if somehow we found out they tested positive for it they would probably treat them w/ antibiotics but if they continued to test + they wouldnt treat any further and wouldnt worry about it unless it caused problems. He said it wouldnt be anything I would have to disclose to the school district when he started either. (if the antibiotics fail and he remains + that is) One of the nurses said they havent seen an effect CF wise in patients who carry it. But they would like him not to have it so he had more options when it comes to antibiotics seeing MRSA is resistant to the penicillin family. They also said there are different strains of MRSA, there is hospital acquired which seems to be more difficult to eradicate and community acquired which has a better chance. I asked about the bleach baths again and he said we do have staph on our skin. Although MRSA likes the nasal and sinuses more, it is present on the skin also. By taking the bleach baths it just helps reduce the amount of bacteria present and helps the drugs do their job.

So, in one breath they make me feel like "no worries, lots of us have it...we're exposed to it all the time. Less than 1% of people actually show symptoms and have the boils/lesions. He'll be fine." Then the next breath though they are all dressed in gowns wearing gloves talking about how he'll have to be on isolation from now on until/if his cultures are negative for 3 consecutive months.

The Dr himself said he understands our confusion and that he agrees the medical field is kind of hypocritical when it comes to treating. One breath, no big deal, the next VERY big deal.

I asked about the rest of us getting tested. He said he thought it would be a waste of time, as they probably wouldnt treat us anyway. He also said that very recently they've started testing everyone who is admitted to the hospital especially for surgery for MRSA. If they test + then they treat them w/ antibiotics prior to surgery but then that's it. They do no follow up w/ that patient regarding the MRSA.

I was kind of peeved though for the fact I found out yesterday that at his Feb 8 clinic he did test + for staph. Not MRSA but a staph and not only did they not let me know that but they didnt do anything about it either. I asked him why not? and he said they dont treat for a staph unless he was sick which he wasnt. Dont get that though...isnt any/all staph not good? Whatever, cant do anything about that now either.

So, he is on Clindamycin and Rifampin (which is a dark red color) The Clindamycin is the yucky one...3xs/day for 10 days. Not going well. I went to Walgreens today and had them flavor it thinking maybe that would help but nope. Put a little in pure grape juice (they flavored w/grape) but nope. So I have to pin him down and try my best to get him to swallow it. The Rifampin doesnt smell like it would taste bad but he wont take that one either. AND that one stains like mad! I feel bad, he gets so totally pissed at me he doesnt even want me to hold him when he gets done. He runs to his big sister and makes her hold him:( He also has some ointment that we have to put in his nose 2x/s day for 7 days. Once he's done w/ these two antibiotics he'll get another refill on the Rifampin and then start Bactrim. He'll be on something for a total of 28 days.

As far as other people that carry MRSA - it is estimated that about, depending on who you believe, 30 to 70% of nurses in a hospital setting carry MRSA in their nose or on their skin. I think the best way to really grasp how it is different is to think of all these bacterias as completely different for a CFer. Like the docs said, MRSA hasn't been shown to do a lot of damage so far, so a lot of clinics treat it, or don't, like your docs do. The biggest difference is for the CF community it can get into our lungs because we don't have the ability to naturally clear our mucus as the rest of the population does. As I said before that's the key difference when it comes to all of these bacterias. So although many healthcare workers will have MRSA it never makes its way to their lungs because they can “naturally” fight it off. Like your medical team is saying it's not something that you have to disclose to the school district because it's not something that can spread to the general population from your son.

The “he'll be fine” attitude is very common in the CF community towards MRSA. It is true that more likely than not MRSA will not have a major impact on his health anytime soon (as far as studies have shown and what the American healthcare community believes). They were wearing gloves and gowns because it is of course better not to spread MRSA to other patients if they can avoid it. Even though it may only be a 1% chance to develop into skin lesions, they certainly don't want to take that chance with passing it on to others.

Confusion is expected. Remember that medicine is comprised of educated guesses. It's often the doctors that make the most correct educated guesses that are considered the best doctors :)

I agree that getting the rest of the family tested would in fact be a waste of time. If you wanted to take it upon yourself to do some bleach baths and some nasal washes it certainly wouldn't hurt, but it also wouldn't necessarily take the chances down to 0% that you would carry MRSA. Also keep in mind that your son may very well of not have gotten MRSA from your family and picked it up in clinic or out in the community, which is probably more likely.

Each clinic has a different response to staph. Some will treat aggressively right away and some will do what your clinic did - not treat unless symptoms are present. I would venture to guess that most CF clinics take the stance that your clinic does and that is not to bombard the body with antibiotics unless it's absolutely necessary. Not saying that I agree, just saying how it is.

I know it's tough for a little guy to understand but there will be a light at the end of the tunnel if he sticks with it. It can be so frustrating taking all of those meds but you just have to do the best you can with making them understand that as it is in fact all worth it (may be impossible with a 1 year old). I know you yourself can get frustrated, angry, disappointed and sad but make sure you always show him strength and commitment because that's exactly what he needs modeled from his parents.

MRSA and Cystic Fibrosis

Here's another question from a reader that I thought most of you would find interesting. MRSA and other types of bugs are always a hot topic in our community so I figured it would be helpful to share this exchange. Remember when reading this that I am not a doctor (far from it) and I'm only sharing what has been told to me and what I've experienced.

I know from your blogs that you have MRSA. A dr just called and told me my son's last culture came back positive for it. :( What the hell does this mean for him? He was sick w/ a viral thing about a month ago and aftert a couple of weeks he was put on Sulfa and it seemed to work for a little bit but then his drainage turned back to green so our family dr (his cf dr was out that day) put him on Zithromax. That seemed to do the trick. Well, apparently, the fact that he didnt respond to the Sulfa made the cf doc suspicious and asked that we do a culture last Friday even tho we have a clinic tomorrow. He said we will treat him aggressively w/ antibiotics and hope that we can get rid of it? I thought once you have it you always have it? I am so confused...he also mentioned doing bleach baths?? WTH?? I thought it was transmitted thru blood but he said no mostly mucus, like snot? What do you think/know about this?? I dont even want to tell our family he tested positive (but I guess I have to to protect their kids from it?) b/c I dont want my son to be treated like he has the plague. Crap.

I'll try to answer your questions best I can and in order :)

We're not sure what it means. Some doctors will say that MRSA has no known long term effects on lung function while some believe that it can present a problem.

Treating aggressively is a good thing. Obviously not having it is better than having it.

The longer you have MRSA the less likely it is to go away. Treating early and often is key. You can get rid of it.

Never heard of bleach baths. When you find out what that is, let me know.

You may be thinking of MRSA/Staph found on the skin as far as the blood goes. This is different. It's actually found in many people's nostrils but because they have a normal mucociliary clearance system, it never gets to the lungs. It can be transmitted to other CFers via sneeze, cough, mucus, boogers etc.

You don't have to worry AT ALL about others in the family. I've talked at length with my doctors about this and the chance to "pass this on" at any level (to non-CFers) is very very little. I've asked about old people, babies, etc and they said not to worry. In theory, anything is possible. but getting others sick with our MRSA is very improbable. Think about it, Mandi would be sick! She's fine :)

Don't freak out mama. Encourage them to be aggressive and then hold on for the ride :)

I guess I better make my list of questions for his clinic tomorrow. Dr said that the bleach baths have be proven to help rid of the MRSA. I asked "why, is the bacteria on the skin?" and he said yes, it can be. Now, you say that is a different kind of MRSA? There are two kinds? He did mention it being a type of a staph. So maybe he doesnt have the same MRSA as you have? I know he didnt have it at his last clinic which was Feb 8, that culture came back negative for everything tested.

Weird thing to me is that he is fine right now, no symptoms of any sort. And his CF doc told me today that the zithromax wouldnt have gotten rid of the MRSA (obviously, seeing his tested positive after taking it) but my point being if he didnt have CF or it was one of my other kids, if they no longer had cold symptoms or any other symptoms I wouldnt think to have them be tested for anything else. And guessing neither would the dr. He mentioned that some carry the bacteria and are not symptomatic. Maybe he got it from one of us? I guess we'll all be getting tested for this:(

Oh Ronnie, do you cringe when you see you have mail from me??!! I am a treat aren't I?

There is stuff that they had me wash with when I first had MRSA, but I think it was only a nasal wash.

Generally speaking, if you hear about it on the skin, it's staph, not MRSA. We both have it in our lungs and it's the same bug. And it gets confusing, but MRSA is staph, but a staph that is resistant to the drug they usually use to treat staph. CFers can get both staph and MRSA in the lungs.

I don't feel any different since getting MRSA (2003) and my lung function hasn't declined because of it. I don't have increased exacerbations either. My doctors have never given my MRSA a second thought and don't seem to think it's a big deal.

You don't have to worry about having your family tested.

Keep the questions coming, that's why I'm here :)

But what if we carry it and we're the ones who gave it to him? Or would he have had to have gotten it from another CFer? Who knows, I suppose. I'll have to have the Dr clarify all this for me tomorrow. My son started on both the antibiotics they prescribed for him tonight already. Poor guy, one of them smells and probably tastes too, like cat urine. Dr warned me about that one. Real fun part is he has to have that one 3x's/day for 10 days. The other one, the yummy one, only 1x/day for 10 days. Nice.

So the MRSA you have doesnt cause the skin boils or anything? It's just a bacteria in your nose/snot? How did you find out you had it?

You can certainly try and take steps to prevent yourself from "passing it on" to your son, but I have a feeling that the doc will say that there isn't much you can do. It would be really hard to track down how the MRSA got to him and you'd probably drive yourself silly thinking of it. It's there now and all you can do is try to eradicate it the best that you can.

I've had the cat urine drug...wait until he starts marking the corner of your living room...just kidding.

MRSA will not cause skin boils. You have to think of our lungs and our skin as two different ecosystems if you will. MRSA in the lungs is a completely different ball game than MRSA/Staph on an open wound in your skin. I've asked the doctors before if I could cough on an open wound on my body and infect it with MRSA. Their answer: In theory it is possible, but very improbable.

I cultured MRSA after a routine sputum culture during one of my many hospitalizations. [END]

Hope you guys were able to get something from that! If you ever have any questions that come to mind, please don't ever hesitate to contact me by email or through CysticLife or Facebook.