eradication of MRSA

Question

My daughter, 17 years-old, has been tested for the first time positive for MRSA, only in the sputum. It is planned to try to get rid of it now. How can this be achieved and how great are the chances of having quite a durable success? In case she will change over to an adult CF-center which provides special rooms for patients with problematic germs, how great is the risk of aquiring further germs (my daughter is free of pseudomonas and the MRSA has no effect on the clinical status?). Furthermore my daughter wants to know why she is being isolated while hospital staff is not even examined and if she has to fear up to now at any contact with others (in the freetime, school, work)- assumed the eradication is successfull - to get infected again.
Right now there must also have been a source of the germ somewhere.
How do other teenagers cope with the situation to be treated as a leper? Please give me an answer as soon as possible as I do not know how I can help my daughter. Concerning her health she is stable, in contrast to her psyche at the moment.

Answer

Hello,
MRSA (methicillin resistant Staphylococcus aureus, resistant to the usual antibiotics) are indeed a problem for institutions, such as for example hospitals. For eradication, many different, often very far-reaching approches are undertaken. This includes the administration of various antibiotics locally (e.g. at the nasal mucosa) and/or via the blood (systemically) and hygienic measures at home. For details, please contact your local CF-centre, which for sure has information on the topic MRSA. These recommendations can be retreived at all CF-centres in a slightly different version.
Regarding the worldwide increase of MRSA, the proven worsening of the course of the illness in other groups of patients and the problem of finding an adequate therapy, each colonization with MRSA should be consequently treated. There are clear instructions from the "Robert-Koch-Institute" (German central institue of the government for the field of supervision and prevention of illnesses) how to deal with patients positive for MRSA. Please find also detailed information on the website of the German patient organization (www.muko.info):
The chances of a durable success are good, as long as there is no hidden risk of reinfection, e.g. via other close contact persons. 10-20% of the population are permanent colonized with S. aureus, 15% of the S.aureus species of CF-patients are MRSA. Therefore it is important to look for the colonization status of close family members and to treat their probable colonization, as well as to put an emphasis on disinfection of the hands of close contact persons as the most important source of infection. If you keep this in mind, you do not have to fear a reinfection at any single contact to other people.
An areal separation of MRSA to others is not only the rule in adult CF-centres. MRSA is a problem in hospitals generally and is treated as this always in the hospital. Unfortunately, it is mandatory to separate those patients with MRSA from those without MRSA, regarding the complicated therapy of such germs and the increasing appearance. This is the rule in children CF-centres as well as in adult CF-centres. You do not have to fear to aquire another germ due to the separation of patients, as the profile of germs is known in the patients and contact time of patients in the outpatient departement shoud be organized as such that there is no increased risk to get another new germ, as well as strict hygienic measures should prevent an infection.
We know that it is hard for you, because your daughter feels treated like a “leper”, but unfortunately it is important to prevent spreading of this germ and we hope that after a successful eradication your daughter does not have to take care for all these separation measures anymore.

Yours sincerely,
PD. Dr. M. Ballmann

21.04.2008