Recurrent staphylococcal infection: Natural history
- Virulent strains of Staph. aureus (including golden staph- MRSA) are responsible for recurrent skin and soft tissue infections (eg. boils)in previously well individuals (children and adults). The infections may recur over many months. Eventually some degree of immunity develops and the episodes become less frequent. However episodes may continue to occur for up to 2 years.
- In general, there is no detectable problem with a person’s immunity to explain the infections.
- Sometimes the infections may enter through skin that is shaved as shaving creates small abrasions (cuts) that allow the staph to enter the skin and set up and infection.
- Any sort of wound, cut or injection site may also become infected easily if the person is carrying one of these aggressive strains.
- Spread of infection within sporting clubs, daycare, prisons, residential care, schools and other closed communities well-described.
- “C – Factors” contributing to MRSA spread (Centres for Disease Control, Atlanta) –
- Contact (direct skin to skin)
- Cleanliness (lack of)
- Compromised skin integrity
- Contaminated objects, surfaces
- Crowded living conditions
- The sixth C= ‘Capsules’ – antibiotic exposure
- Avoid antibiotic treatment unless you have a serious infection! The over-exposure of people to antibitics is responsible for the emergence of multi-resistant Staph. aureus strains such as the community golden staph (MRSA) that is spreading across Australia at present.
- Improving the condition of your skin- treatment of dermatitis, scabies or other conditions that make it easier for infection to take hold. See also Routine Skin Care.
- Hygienic management of cuts and scratches
- Avoidance of shaving- especially of axilla (use clippers instead) if boils have occurred there and other skin trauma
- Use regular antiseptic body washes (eg. 4% chlorhexidine solution or triclosan) during showering may prevent relapse of infection for a period, allowing the skin to heal. Dilute bleach baths three times weekly may also be effective. In general start topical treatment frequently (daily or thrice weekly) and scale this back to weekly treatment provided it remains effective. Continue for 3 months. Note that triclosan resistance of staph. may reduce the effectiveness of that treatment. Resistance to chlorhexidine is rare and there is no resistance recorded against hypochlorite (bleach). Watch out for drying of skin or exacerbation of dermatitis. Apply emolients PRIOR to bath – see Routine Skin Care.
- Decolonisation: if the infections are able to be prevented with body washes and the skin is healed well, it may be worth considering a topical decolonisation to reduce the staph load significantly.