Non-thyroid question --- Are there any Nurses (or anyone else) here with a thought on MRSA / MSSA

[mommy2two2008]

Well - you probably already know my saga - I got a "staph infection" from my tubal ligation.  Spent a week in the hospital.  Now, this past Tuesday, I got a call from my GYN saying I had MRSA.  On Wednesday, I went to the follow up with the surgeon that was called in to oversee my hospital stay and he said I am cured and I had MSSA (Methicillin SENSITIVE Staph A).  I went to my GYN for follow up yesterday, and he said I have MRSA not MSSA.

This is what the culture says:

Gram Stan Wound - Final    Rare WBC's; Few Gram Positive Cocci

Culture wound aerobic Final - Organism 1       Staphylococcus aureus Heavy Growth

Staphylococcus coagulase nagative isolated also.  Probable contaminant(s)

1. Staphylococcus aureus ------ (now - this is the tricky part - S= Sensitive to -- R= Resistent to)

Gentamicin = S
Levofloxacin = S
Nitrofurantoin = S
Oxacillin = S
Rifampin = S
Tetracycline = S
Trimet / Sulfa = S
Vancomycin = S
Clindamycin = R
Erythromycin = R
Penicillin = R

Now, I am completely and utterly confused.  The surgeon said that since it was SENSITIVE to so many meds, I had MSSA (not as bad as MRSA) and that I was cured, the wound had completely healed and I was free to roam with the rest of society.

The GYN said that since the staph was RESISTENT to any medication, especially Penicillin, I have MRSA and he did not know why the surgeon said otherwise.

I also asked my kids' pedi - since one indicates the need to treat my children and the other does not.  (Mind you - I started treating my children on TUESDAY when I initially got the call - its just Bactriban in the nose once a day for 2 weeks).  Now, very interesting is that the pedi said it is BOTH.  It is not the old MRSA that you used to see in hospital settings because a number of medications could kill it (sensitive), but it is not clearly MSSA either, it is both.  He said tha that I should be very weary to go anywhere near my mother-in-law with cancer and that I should continue to treat the kids and take extra precautions to not infect the kids.  He also suggested that 2 weeks after I finish the antibiotic I am am taking, I should have my nose swabbed again.  If it is positive still, then further measures need to be taken on swabbing my kids, etc.

PLEASE TELL ME, WHAT DO YOU THINK ABOUT THIS?  Why is nothing ever black and white with me. Like I told the GYN - if it CAN happen, it WILL happen with me.

Thanks! ~K

[peekawho]

Its always a good idea to report any unusual events that occured as a result of surgery.  

You likely got this either from a surgical instrument that was not properly sterilized, from improper prepping of the operative site, or from someone's improperly washed hands who cared for you in the hospital.  Or possibly from you yourself touching the wound with unwashed or partially washed hands.

These will not likely happen again.  It was probably just an unfortunate occurance; it happens.  

But its always worth mentioning.

[mommy2two2008]

LOL - Kitty - I responded then all of a sudden, you were there! LOL - Thanks a bunch.  Really means a lot to me to know this will be o.k.

One more pestering question, do I need to report this MSSA to any doctor for future surgeries (like if they decide to remove my thyroid)?

[mommy2two2008]

Kitty - I hope things go well for your appointment on the 6th.  So, what is the treatment for Lyme anyway.  I have often heard it was hard to diagnose.  I glad they finally gave you answer to start you on your way.  Thanks for coming in to answer this question.  I really appreciate it.  I assume it is safe for me to be around my mother in law?  Also, the MSSA does die off with the antibiotics, right?

Peek - Thanks to you as well for your wealth of knowledge and lending a hand to me on this board.  I know I see ya from time to time in here and we all appreciate your insight.  

You both are a blessing to MH!!! Hugs ~K

[kitty9309]

That should do the trick since the Staph is sensitive to levofloxacin.

[mommy2two2008]

.... for ten days.  I am on day 6 of the treatment.

[mommy2two2008]

I am on Levaquin - 500 mg 1 x a day.

[kitty9309]

The numbers next to the S or R refer to the Minimum Inhibitory Concentration (MIC). That is the amount of the antibiotic needed to inhibit the bacteria's growth in-vitro (outside the body on the lab test)
The MIC can gove the doctor an idea of whether to use a drug, even if the result is R. Sometimes a higher dose of a drug marked R can work if the MIC is low enough.

I have been neglecting this Thyroid Forum a bit (sorry) because I have been diagnosed with Neurologic Lyme Disease (and possible a co-infection called Babesia- it is like Malaria and is transmitted via ticks along with Lyme).I have had this for 14 years.
My main symptom of vertigo/dysequalibrium is not related to my hypoT as I had hoped. My TSH has been 0.93 for 2 months now.
I see a Lyme Literate Doctor, recommended by my endo who first suspected Lyme, on November 6.

Which antibiotic are you on for the Staph now?

As Peekawho said, Staph is normal and is everywhere. We all carry it on our skin to a small extent.

[peekawho]

I personally don't think you have to be horribly concerned about every little thing down the road.  This was a hospital acquired infection, you're on antibiotics that it is sensitive to, you are healing well, and things should be just fine.  This should likely be a one time freak occurance.  You know where it came from, and its sensitive to lots of things, unlike really virulent, dangerous forms of MRSA that are resistant to everything.

It won't hurt to treat your children, but remember that SA is NORMAL, and is found everywhere.  Handwashing and good basic hygiene are really all you need.   PLEASE don't let this freak you out!  

I wish I knew what the sensitivity numbers meant. I just know they mean SOMETHING!  Your doctor should know.  Or the ped--I'm sure you'll be back there...bring the test results if you haven't already.  

[mommy2two2008]

Well, the staph being resistant to Penicillin was - to me and for my situation only - not a big deal, I am DEATHLY allergic to Penicillin!  I was also deathly afraid of this being MRSA too, but it is great to know my GYN can be wrong (I keep saying it --- Love the man to death, he is SUCH A GREAT DOC).  I had/have no hard feelings, but was really uneasy about the whole thing!

[mommy2two2008]

By the way Kitty ---- Where u been???  We've missed you!

AND THANK YOU SO MUCH FOR TELLING ME THE DIFFERENCE SO I CAN UNDERSTAND!!!!!!!  

This is good news, right?

[mommy2two2008]

So Kitty- once I finish the round of antibiotics - I don't have MSSA anymore???  The consult surgeon put it that way, but my GYN said the surgeon was wrong.

So confused!

[kitty9309]

Your GYN is wrong.

Many staphs are resistant to penicillin.The Penicillin result has no bearing on this being MRSA or not.

Your Staph Aureus sensitivity above is a very typical one. It would be nice if the penicillin was sensitive, but most are not anymore due to the heavy use of the drug for various infections.

[kitty9309]

The Oxacillin result predicts if the Staph Aureus is MRSA.

Oxacillin and Methicillin are interchangeable drugs. (like penicillin/ampicillin)

Your Oxacillin is sensitive, so you have MSSA, not MRSA.

In my lab, we do not test Methicillin directly, we use Oxacillin instead.

I am a microbiologist. Just the other day, we had a doctor call and ask us why methicillin was not tested. The doctor didn't even know that oxacillin is the same drug!

[mommy2two2008]

Peek - WOW - thanks so much for that!  Really!

There are numbers associated ---- here they are:

Gentamicin = S      (<=0.5)
Levofloxacin = S      (0.25)
Nitrofurantoin = S    (<=16)
Oxacillin = S           (0.5)
Rifampin = S           (<=0.5)
Tetracycline = S      (<=1)
Trimet / Sulfa = S    (<=10)
Vancomycin = S     (=0.5)

The report also mentions that there were no Anaerobes isolated in 5 days.

See I know what you mean about it actually came from my surgery.  I know - informed consent, known complication.  What I did not know was the incidence that my children could however, get it from me.  I have to take other precautions now (like spraying the tub down right after I shower and no longer letting anyone in my family use those lufa sponges - we call 'em scrubbies).  That's what they told me anyway.  

My infected incision site is completely healed now.  The others were fine during and after the infection (I had 4 entries all together - laparoscopic procedure, but with some minor changes -- he was not going to go in my belly button, was going to an abdominal incision to the left of the BB but, he could not fully get to where he needed to be so, he closed that one and went in the BB after all).  I am 7 days past the hospital stay and 6 days into the 10 day Levaquin treatment.

My real concern is the possibility of some abcess down the road that could be horrible.  There was also a kid who died here from MRSA pneumonia 4 months after he was treated for an MRSA infection under the arm.  I mean, wow, can't be too careful.  Also, my little girl is sick and she has been since I was in the hospital.  I took her back to the dr yesterday and her ear drum sort of ruptured (she has a tube, but it is blocked in that ear).  The ear drum is "deflated" .... the pedi's words... and there is puss collecting in her ear cannal.  She is running a fever.  This was not there 3 days ago when I brought her for fever and swollen glands in her neck.  They checked her for mono then but we don't have the results back yet.

Anyway - horrible stuff this is.  I just want to know for sure if I have to be concerned with every little thing down the road because of this infection.

Thanks peek really!  It does make me feel better to know that it does not seem to be needed to treat my kids.  My pedi is really careful though, which I like.  Both my children have been hospitalized several times with pneumonia so he is over cautious with them.

You were a BIG HELP!

Thanks Cheryl!  Please keep the tiara!

[peekawho]

Anytime!  I'm not sure how much help I was, though.

[ChitChatNine]

Thanks so much Peek for stoppnig by to help out Mommy2two2008 .. we really appreciate it and WELCOME to the Thyroid Community.  

Peekawho is CL of Maternal Child and Healthy Cooking Communities and is a R.N....

C~

[peekawho]

This is confusing indeed.  I'm not sure about how it can be resistant to penicillin, yet sensitive to oxacillin.  
Where there, by any chance, numbers next to the S's and R's? Sometimes there are numbers present that indicate HOW sensitive or resistant the organism is.  Perhaps it was only slightly sensitive to oxacillin.
Where there other antibiotics that you didn't include on the list?  Most importantly, methicillin?

(MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA).

The good news is that it was sensitive to most other antibiotics.  It shouldn't be hard to treat.  I'm not sure that all would agree that your children have to be treated....this isn't bubonic plague.  I'm not an infectious disease specialist or MD, so don't go by what I say.  But this likely came from your surgery, not the community, so what is the point of treating your children?  

I'd ask your regular ped to consult with an infectious disease specialist as to the necessity of treating the kids--he should shoot this one by a specialist.  But you indicated you were already treating, so it is a moot point.

There noses will be free of staph.  But that's it.  So the ped who wanted you to treat can feel ok about that.  But SA is everywhere.  Not just the nose.  I personally don't feel any reason to get panicky about it.  Use good handwashing, keep the kids from picking their noses, and do all the things we all do with our kids.  

But you got your wound from surgery, NOT the community.  So I question the value of treating your kids as though you have CA-MRSA (community acquired).  And its sensitive to loads of other antibiotics.

I could be wrong, but I'm not at all sure there is much value in treating them.  You didn't get it from them, and if they don't play with your infected wound and basic hygeine measures are observed when changing bandages (such as washing hands with soap and water, disposing of soiled bandages where no one will contact them) , they won't get it from you.

[mommy2two2008]

Thanks Cheryl!  I tried searching it several ways on MH, but did not get anywhere!  Really appreciate it. ~K

[ChitChatNine]

OH MY GOSH ... see what you can find out here ... if nobody knows the difference, I'll see who I can find online that has a med background to help out .. but somebody here is a microbiologist ....... ?

I know a few CL's who are RN's so PM me if you need more info ok?

C~