Natural history of recurrent staphylococcal infection

• Types of Staphylococcus aureus (including MRSA) can cause recurrent skin infections (e.g. boils) in children and adults who are otherwise well. The infections may recur over many months. Eventually the episodes become less frequent or disappear as the body (immune system) learns to deal with them. That may take up to 2-3 years.
• Almost always, there is no detectable problem with a person’s immune system to explain why the problem has appeared
• Shaving is a risk because it creates small cuts in the skin – close clipping is preferred
• Any wound, cut or injection site may also become infected – therefore avoid unnecessary injury/ scratching as much as possible
• Staph. infections can spread easily from person to person within sporting clubs, daycare, prisons, residential care, schools and other closed communities – if you think this is happening, then contact the Public Health Unit in your region

Prevention

• Avoid oral antibiotics for this problem as much as possible – it is better to start treatment with an antiseptic cream or ointment applied early to the new lesion 3-4 times per day, continuing for 5 days. If that does not work, consult your medical practitioner or local emergency.
• Closely control exzema (dermatitis), scabies or other skin conditions that you have.  See also Routine Skin Care.
• Clean and disinfect cuts and scratches and apply a bandaid if necessary. Clean your hands before and after care with alcohol hand rub or hand wash.
• Avoid shaving especially of armpits (see above)

Management 

1. Use regular antiseptic body washes (eg. 2% aqueous chlorhexidine solution or 1% triclosan during showering or Dilute bleach baths) .  With showering, apply the antiseptic to all of the body including scalp and allow to it to stay on skin for at least 3 minutes before rinsing).  This may prevent or reduce further events and allow the skin to heal.  Start daily or thrice weekly and reduce to weekly provided it remains effective. Continue for 3 months.  Watch out for drying of skin or exacerbation of dermatitis.
2. If significant boils continue, obtain further advice –  eradication treatment may be indicated
3. Eradication treatment: if the skin is healed, eradication process- this involves use of nasal antiseptic ointment and antiseptic body washes for 5 days together with cleaning the house; all members of the household are usually treated without testing. See this Patient Instruction.

References

• Medicine Today Preventative Strategies for Recurrent Staphylococcal skin infection Ferguson 2012-09-065