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Staphyloccocus aureus

Question
Hello,
our daughter (13 months) has been diagnosed with the germ Staphylococcus aureus in the throat swab.

She has it - since her diagnose 10 months ago - now for the second time. Apart from the mucus she has, which she can cough out very well however, she has no symptoms of infection. We inhale two times a day with NaCl and salbutamol as well as ipratropium bromide.
Our CF-center does not regard it as necessary to give an antibiotic. When the germ occured for the first time, however, the former physician of our center prescribed a cephalosporine. In the meantime there has been a change of the physician in charge.
Is it now right that she does'nt take an antibiotic?
Will she get rid of the germ again?
Is this germ "dangerous"?
How can she get this germ as we have no animals and she has had no contact with animals?
I would be very pleased if you could answer the above mentioned questions.
Many thanks for your efforts.
Answer
Hello,
you ask, if an antibiotic therapy is necessary for your 13 months old daughter, in whom now for the second time the germ Staph. aureus has been diagnosed or if such a therapy can be abandonned, like your acutal physician in charge proposes. At the first detection of Staph. aureus the former physician in charge prescribed a therapy with a cephalosporine. You report further, that your daughter has mucus, which she could however cough out well under the current inhalation therapy with saline, salbutamol and ipratropium bromide.

The colonization of the airways with Staph. aureus is judged differently by specialists of CF patients. There are centers, in which always an antibiotic therapy is initiated if the resp. germ can be detected. Other centers recommend the therapy depending on the clinical findings and probably accompanying laboratory findings. As you report that your child has mucus, one has to assume, that your daughter has the typical increased production of mucus of a CF-child. In case of a 13 months old CF child, it is the aim of the physicians in charge to have and to keep a normal lung result as possible. That means, that increased production of mucus is not desirable and should be depressed by therapeutic options as far as possible. Without knowing your daughter personally, I would therefore recommend a new antibiotic therapy due to the story you tell.
One has to realize that, however, that in many CF patients, Staph. aureus can be detected again and again in spite of repeated antibiotic therapies. There are therefore also so-called permanent colonizations with Staph. aureus. Then it is even more important to pay attention to the clinical findings and to make the therapeutic regimen of choice according to this. In this situation it is important, that parents and therapists are consent on a more or less agressive therapeutical regimen which is acceptable for all.
Staph. aureus is a so-called environmental germ, which can be also found on the skin of all human beings, for example. In the end one can not protect oneself of a colonization of the airways with this germ, if one wants to lead a rather normal, humane life.
The germ has the potential of causing damage to the lung. Therefore one should treat it at least in case clinical symptoms make it appear to be necessary.
I think it is very important that you address the topic openly with your CF-doctor in charge and to be consent on a common strategy.
Yours sincerely,
Dr. H.-G. Posselt
09.02.2011