Pediatric Skin and Soft Tissue Infections (Staph and MRSA)

Prevention and Risk Assessment

• How is Staph infection transmitted?

  Staphylococcus bacteria, including MRSA, is transmitted by direct skin-to-skin contact or contact with surfaces that have come into contact with someone else's infection (such as towels, used bandages).

• What is MRSA in children?

  Staphylococcus aureus (staph) is a type of bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) is staph that can’t be killed with common staph antibiotics, such as cephalexin. MRSA is usually limited to the skin. But it can be life-threatening if it spreads to the lungs, the bloodstream or other organs. MRSA infection can be harder to treat than other staph bacteria, but there are oral and IV (intravenous) antibiotics that can successfully treat it. The infection can be easier to treat if caught early.

• What causes MRSA infection in a child?

  A child normally has many germs on his or her skin and in nasal passages. About a third of people in the U.S. carry the MRSA bacteria. Many people with MRSA don’t know it. These germs normally don’t cause a problem. But MRSA can cause an infection if a child’s skin gets scratched or cut, or his or her immune system is weak. The infection may be a small blister, multiple blisters or a boil of the skin, or it may spread into the bloodstream and cause widespread problems.

  MRSA infections were first seen mostly in hospitals and nursing homes. MRSA infections are still most common in a hospital. But as more people carry MRSA on their skin and in nasal passages, the risk for infection outside healthcare places is higher.

  A child may pick up MRSA by:

  • Touching someone who has MRSA on his or her skin
  • Being nearby when a person with MRSA coughs or sneezes
  • Touching a surface that has MRSA on it
  • Touching the wound of someone with a MRSA infection

  If MRSA gets through your child’s skin through a cut or other wound, he or she may get an active MRSA infection.

• Which children are at risk for MRSA?

  A child is more at risk for MRSA if he or she has any of these:

  • Close contact with people who have MRSA
  • A scrape, cut or other skin injury
  • A tattoo or piercing
  • A previous infection with MRSA

  MRSA infections are more common in groups of people that spend a lot of time close together. This includes children on a sports team. MRSA may be on sports equipment and clothing and may transfer from skin to skin during play.

• How can I help prevent MRSA in my child?

  You can help protect your child. Teach your child to do the following:

  • Wash hands often. Teach your children to wash their hands with soap and water. Wash your own hands often, too. This will help stop all kinds of infections from spreading, including MRSA. When soap and water aren't available, use a hand sanitizer that contains alcohol.
  • Keep bandages on wounds. Keep sores and cuts covered and clean until they heal.
  • Don't touch sores. Teach children not to touch sores and scabs. That includes their own sores and scabs, and those on other children.
  • Stop scratching. Don’t let children scratch their skin too much. This can create breaks in the skin where bacteria can enter. Use an anti-itch cream on some areas if needed. This is very important if they get chickenpox or another itchy disease.
  • Don't share personal items. Tell children not to share personal items such as towels.
  • Be careful around people in a hospital. When visiting loved ones in the hospital or other care facility, tell your child to not touch catheters, ports or IVs where they enter the skin. Everyone should wash his or her hands with soap after leaving the room.

  Children may be at risk in crowded places where infections can spread easily through contact. This includes daycare. Ask about the steps taken to prevent the spread of infection. These should include regularly disinfecting surfaces, toys and mats.

  Children who play sports are also at more risk for infection. They need to take extra care and do the following:

  • Keep all cuts and scrapes covered.
  • Don't compete in contact sports with a wound that is open or bleeding.
  • Shower right after competing or practicing.
  • Shower before getting into a hot tub with other athletes.
  • Keep sports equipment and supplies clean.
  • Wash uniforms after each use.
  • Check with coaches to make sure shared sports equipment is cleaned and sanitized.
  • Don’t use equipment or clothing that has not been cleaned.

  If you or your child has a MRSA infection, tell people in your household, school and sports teams. They can take steps to protect others from infection.

• When should I call my child’s health care provider?

  Call the healthcare provider if your child has:

  • Symptoms of MRSA
  • A MRSA infection that is not healing or is getting worse

  Get medical care for your child right away if you notice symptoms. A MRSA infection can quickly become severe if not treated.

  Don't try to treat a MRSA infection on your own. This can spread the infection to other people or make it worse for your child. Cover the infected area, wash your hands and call your child's health care provider.

Diagnosis

• What are the symptoms of MRSA in a child?

  A MRSA infection is most often a skin infection. But sometimes the bacteria get through the skin through an open wound. For children, the most common place of infection is through a simple cut or scrape.

  The symptoms of a MRSA skin infection may include any of the below:

  • Bump that is painful, red, leaking fluid or swollen. It may look like a spider bite, pimple or boil.
  • Bumps under the skin that are swollen or firm
  • Skin around a sore that is warm or hot
  • Bump that gets bigger quickly or doesn’t heal
  • Painful sore along with a fever
  • Rash or fluid-filled blisters
  • Boil or sore (abscess) that leaks fluid

  Signs of a systemic infection include any of the above, plus:

  • Fever
  • Chills
  • Severe headache
  • Sleepiness
  • Dizziness or fainting

  This type of infection needs treatment right away.

  The symptoms of MRSA can be like other health conditions. Make sure your child sees his or her health care provider for a diagnosis.

• How is MRSA diagnosed in a child?

  The health care provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:

  • A skin swab, to check for MRSA
  • Cultures of samples of blood, spit or fluid from a sore to check for MRSA
  • X-ray of the lungs, to see if the lungs may be infected
  • Echocardiogram of the heart, to see if the heart may be infected
  • CT scan or MRI, to see if any other tissue, bones or joints are infected

Treatment

• How is MRSA treated in a child?

  Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. If caught early, a MRSA infection can be easy to treat.

  If your child has a mild MRSA skin infection, the health care provider will likely treat it by opening the infected sore and draining out the fluid (pus). You might be given a prescription antibiotic ointment to use on your child. Your child might need to take antibiotic medicine by mouth. Your health care provider will tell you how to keep your child’s wound clean and covered while it heals.

  If the infection has spread to other parts of the body, your child may need treatment with IV antibiotics in the hospital. In some cases, such as infection of the joints, your child may need surgery to drain the infection.

  If taking antibiotic medicine by mouth, make sure your child:

  • Takes every dose on time as directed
  • Finishes all the medicine, even if he or she feels better

  Many infections can be cured within one week, but others may take longer. Your health care provider may want to follow up and make sure the infection is gone.

  If the infection returns often, your child’s health care provider may advise special bathing such as:

  • Baths in diluted bleach water, with 1/2 cup of bleach in a tub that is 1/4 full of water
  • Washing your child’s body with an antibacterial soap such as chlorhexidine

  Another way to manage MRSA infection is to remove the bacteria from places where they often live and grow, such as the nose. Your child’s health care provider may advise using an antibiotic medicine in your child's nose to kill MRSA there.

  Talk with your child’s health care providers about the risks, benefits, and possible side effects of all medicines.

• If not treated, a MRSA skin infection may:

  If not treated, a MRSA skin infection may:

  • Damage nearby tissue
  • Infect other people through physical contact or contact with contaminated items
  • Turn into an infection that spreads through the body. This may cause blood poisoning, pneumonia, flesh-eating disease, life-threatening shock and death.