MRSA may be the most frightening epidemic since AIDS, and it's already in homes and schools in our communities. That's the news in Superbug: The Fatal Menace of MRSA (Free Press, $26). I've been wondering what to do when my daughter's playmates show up with nasty-looking wounds that haven't healed. One peeled off a bandage and dropped it on our dining room table just the other day. So, how can we keep our families safe from methicillin-resistant Staphylococcus aureus without becoming crazy germaphobes? I called up Maryn McKenna, a Minneapolis-based journalist and author of Superbug, to ask. Here's an edited version of our conversation:
You write about Carlos Don, a 12-year-old San Diego boy who went on a school camping trip and came home with a fever of 104 degrees. Less than three weeks later, Carlos was dead, killed by a MRSA infection that destroyed his lungs. His death came despite getting top-notch medical care. What can parents do to make sure that doesn't happen to our children?
It's a difficult conversation for parents to have. On the one hand, for so many years we've had people being [fanatical] about their kids' germ exposure: buying antibacterial toys, and cutting boards, and soaps, and really overdoing it. Only recently have people started to get the message that being overly germaphobic isn't really good for kids' health. It's OK for kids to have some pathogen exposure because it builds up their immune system and damps down the immune response that leads to allergies. On the other hand, there are some pathogens you really should be concerned about. It's worth being aware of MRSA and taking simple, practical steps to reduce kids' exposure.
What should we do when a child comes to the house with a red, draining wound, or says they've been treated with antibiotics for MRSA?
It's legitimate to call the parent and ask what's up, or ask that the wound stay covered.
What do you to do reduce the risk of MRSA in your household?
Hand washing is one of the simplest and most effective tools we have. I'm a freak for hand washing. I wash my hands when I come in the door. I wash my hands a dozen times when I'm cooking. I operate elevator buttons with my knuckle rather than the pads of my fingers, because we touch our faces with the pads of our fingers.
Schools seem like an ideal breeding ground for MRSA, and there have been outbreaks in schools, particularly when kids share towels or clothes. How can we reduce that risk?
If kids were encouraged to have better hygiene in school we might see fewer cases. I've been talking to parents, and suggesting that if their kids don't shower after gym at school, send them to school with some wet wipes so they can clean the major yuck off. And of course, encourage them to wash their hands often. [Here are 4 ways to reduce the risk of MRSA in kids.]
The bizarre thing about staph is that it's so common; one-third of people carry it in on their skin or in their noses. Why aren't we all getting sick?
It's probably some mystery of the individual immune system. But the number of people colonized with MRSA, the most dangerous form of staph, is growing rapidly. The last estimation of colonization with MRSA is about 1.5 percent of the population, in 2004. From 2001 to 2004 it doubled. So the number is probably higher now.
Are kids more likely to be infected with MRSA than adults?
Nobody knows the answer to that; it seems to make intuitive sense. Lack of cleanliness and frequent skin-to-skin contact are particular dangers for kids.
When I was writing the book I would keep an informal tally of what would show up on Google Alerts. It's clear there's a spike in MRSA cases in kids after the beginning of the school year. Of course, if kids get MRSA in the summer, nobody would notice except their parents. A lot of cases occur in kids who are playing sports that involve lots of skin-to-skin contact.
Over the past couple of years it's become pretty clear that flu infections predispose kids to MRSA-induced pneumonia. [Carlos Don had both flu and MRSA.] That was definitely a player in the H1N1 pandemic this past winter. MRSA didn't used to be considered a cause of community-acquired pneumonia, but now it is. The best thing to reduce that risk is to get a flu shot.
How can we recognize MRSA infections?
The classic sign is what people describe as a spider bite. It's not actually a spider bite, but that's what it looks like. It's a small, hot pimple that's really red, and hurts out of proportion to its size. Often the redness around it spreads rapidly. If something like that is going on, that's worth paying attention to. Maybe the child really did get bitten by a bug, but keep an eye on it. If after 24 hours your child indicates that it really hurts, or the redness is spreading, then it's time to get some attention. Go to your doctor or an urgent care center. It doesn't hurt to walk in and say 'I am concerned about MRSA.' It's not necessarily on people's radar.
We want to get quick treatment for MRSA, but the main reason that staph has become resistant to antibiotics is that the drugs are overused in human and animal care. Are we overusing antibiotics in children?
An incredibly high number of prescriptions written in primary care for antibiotics are pointless because the illness is viral. For a lot of people, it's a lot less satisfying to walk out the doctor's door without a prescription in hand.
But there's also a lot of pressure on parents to get kids treated with antibiotics. Is your day care center going to be OK with watchful waiting instead of antibiotics? Maybe the kid will have to stay home, and you don't have enough sick days to take off work. There are all kinds of pressures on this idea of doing the right thing that make it easier to use antibiotics badly.
You say that back in your grandfather's era, infections often killed young people, and that we may be regressing to that unhappy time. How so?
Before antibiotics were invented in the 1940s, infections used to be the leading cause of death. The scary thing is that now we're moving to a post-antibiotic era. They try drug after drug [to treat resistant bacteria like MRSA], and in some cases there's no antibiotic that works.
Many MRSA cases are acquired in hospitals, and the trend is not encouraging. There's a method widely used in European hospitals that has been extremely successful. You check people at the door, and if they test positive you put them in isolation for minimal treatment until they're not an infection risk. The Veteran's Administration recently adopted that [approach] for its entire medical system, but most other hospitals aren't doing it.
The community side is harder, because it's much more diverse. We need much more awareness among parents and primary care doctors. There's no way to guarantee the level of knowledge your primary care doctor will have [about MRSA]. And we do need to take a hard look at how much we use antibiotics, both in human medicine and in agriculture. Antibiotics are overused in both realms, and drive the continuing evolution in resistance.