Methicillin-Resistant Staphylococcus aureus: The Effects Are More Than Skin Deep.

OBJECTIVES: To assess the psychosocial effects of a methicillin-resistant Staphylococcus aureus (MRSA) diagnosis on the households of children with MRSA skin and soft tissue infection (SSTI). STUDY DESIGN: We constructed and administered an interview to the primary caregiver within the home of a child with a history of MRSA SSTI. RESULTS: Seventy-six households were enrolled. Survey responses were analyzed and grouped into 4 themes: health behavior changes, disclosure, social interactions, and knowledge/awareness. The most common theme was disclosure; 91% of participants reported sharing their child's MRSA diagnosis with someone outside of the household. Forty-two percent of respondents reported a change in the manner in which household contacts interacted as a result of the index patient's MRSA diagnosis, including isolating the index patient from other children in the household. Many households reported adopting enhanced personal hygiene behaviors and environmental cleaning routines. Thirty-eight percent of participating households reported altering how they interact with people outside of their home, largely to avoid spreading MRSA to vulnerable individuals. In addition, many participants perceived that others regarded them with caution, especially at daycare, whereas other affected households were excluded from family gatherings. CONCLUSION: Primary caregivers of children with MRSA SSTI reported changing their health behaviors, altering their interactions with people outside of their home, and feeling isolated by others in response to their child's MRSA diagnosis. The findings of our study highlight a need for community interventions and education to prevent the negative psychosocial repercussions associated with MRSA.

A national survey of skin infections, care behaviors and MRSA knowledge in the United States.

A nationally representative sample of approximately 2000 individuals was surveyed to assess SSTI infections over their lifetime and then prospectively over six-months. Knowledge of MRSA, future likelihood to self-treat a SSTI and self-care behaviors was also queried. Chi square tests, linear and multinomial regression were used for analysis. About 50% of those with a reported history of a SSTI typical of MRSA had sought medical treatment. MRSA knowledge was low: 28% of respondents could describe MRSA. Use of protective self-care behaviors that may reduce transmission, such as covering a lesion, differed with knowledge of MRSA and socio-demographics. Those reporting a history of a MRSA-like SSTI were more likely to respond that they would self-treat than those without such a history (OR 2.05 95% CI 1.40, 3.01; p<0.001). Since half of respondents reported not seeking care for past lesions, incidence determined from clinical encounters would greatly underestimate true incidence. MRSA knowledge was not associated with seeking medical care, but was associated with self-care practices that may decrease transmission.

Pediatricians' perspectives on the impact of MRSA in primary care: a qualitative study.

BACKGROUND: The incidence of skin and soft-tissue infections (SSTIs) has rapidly increased among children in primary care settings since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Recent treatment recommendations emphasize CA-MRSA as the primary cause, performing incision and drainage (I&D) as the primary therapy, and not prescribing antibiotics for uncomplicated cases. It is unknown how this epidemic has impacted primary care pediatricians in terms of their practice patterns and barriers they face to providing recommended therapies. METHODS: 3 Focus groups among 29 primary care pediatricians in the San Francisco Bay Area were conducted. Transcripts were reviewed and coded into major themes by two investigators using modified grounded theory. RESULTS: Substantial changes in clinical practice have occurred since the emergence of CA-MRSA. These include increased office visits for SSTIs, patients with multiple recurrences and transmission within households. Additionally, our participants reported increased visits for mild skin problems due to media reports contributing to fears about CA-MRSA. Participants routinely prescribed antibiotics for SSTIs, however, few performed I&D. Few were aware of recent SSTI treatment recommendations. Barriers to prescribing antibiotics with CA-MRSA activity included concerns about side-effects and lack of local epidemiologic data showing that it is the primary etiology. Barriers to performing I&D included lack of training, resources and skepticism about its necessity. Important clinical challenges included increased time demands for follow-up visits and patient education along with the lack of evidence-based strategies for preventing recurrent infections and household transmission. CONCLUSION: CA-MRSA has influenced the presentation and treatment of SSTIs especially in terms of case numbers and recurrences. Barriers to providing recommended therapies can be addressed through improved dissemination of treatment guidelines and epidemiologic data. Studies are urgently needed to improve the evidence-base for treatment and prevention strategies.

The effect of media attention on concern for and medical management of methicillin-resistant Staphylococcus aureus: a multimethod study.

BACKGROUND: Reports of an increase in the incidence and severity of methicillin-resistant Staphylococcus aureus (MRSA) infections provoked widespread media attention in October 2007. This study attempted to determine whether this widespread media attention led to changes in physician practices related to skin infections. DESIGN: Data collection via LexisNexis, Central New York (CNY) microbiologic laboratory records, publicly available data on Internet search activity, and a survey of CNY healthcare providers allowed for examination of concurrent trends in media attention, public information-seeking behavior, and physician response. RESULTS: During the period of October 15-29, 2007, a roughly 10-fold increase in the number of newspaper and television news broadcasts mentioning "MRSA" and "staph" coincided with a six-to eightfold increase in Internet search activity for the terms "MRSA" and "staph" and a 79 percent increase in provider-reported patient concern with MRSA. In addition, providers reported more frequent orders for cultures and prescription of antibiotics since then. Practices serving urban or low socioeconomic status patients tended to see less MRSA-related concern and activity, indicating a potential disparity in penetration of MRSA information into different populations. CONCLUSIONS: Increased media coverage of MRSA coincided with increased public information-seeking behavior. Self-reported survey data demonstrate that this period was associated with a change in healthcare provider practice, and a concomitant twofold increase in the number of outpatient skin and soft tissue cultures reinforces this link. However, increased public attention appears not to have penetrated urban, less-affluent areas, raising questions about how quickly healthcare information penetrates different patient populations.

Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video.

OBJECTIVE: Dermcidin (DCD)-derived peptide is an antimicrobial peptide produced by the sweat glands. However, the levels of DCD-derived peptide in sweat were decreased in patients with atopic eczema (AE). The effect of viewing a humorous video on the levels of DCD-derived peptide was studied. METHODS: Twenty patients with AE viewed an 87-min humorous video (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, sweat was collected, and the levels of DCD-derived peptide and total protein in sweat were measured. RESULTS: Viewing a humorous video increased the levels of DCD-derived peptide without affecting the levels of total protein in sweat. CONCLUSION: Viewing a humorous video increased DCD-derived peptide in sweat of patients with AE, and thus, it may be helpful in the treatment of skin infection of AE.