A Guide to Staph Infections in Kids

By Ashli N. Collins, M.D.

In our pediatric practice in Oldham County, the start of the school year used to translate into sports physicals, strep throat and an increase in concern over attention deficit disorders. Recently, though, we are seeing a dramatic rise in staphylococcal (staph) infections in our neck of the woods and across the country, especially in high school sports.

Staph itself is not some new “supergerm” that has just arrived from China but common bacteria that lives on our skin. Its advantage is that it has learned to adapt to the antibiotics we have thrown at it for so long and begun to resist our resources to fight it. To understand this new wave of infections among our youth it is important to understand staph-the germ, what infections it can cause and how we can prevent and treat it.

For those who are curious, Staph is a gram-positive organism that can be found in pairs, groups and clusters. It is estimated to live on at least 40 percent of humans and 50-90 percent of healthcare workers. Not only can it live on people, it can survive on clothing (i.e. uniforms, towels), surfaces and other objects (toys, books) for extended periods of time. Most of the time, staph coexists with us and does no harm. Sometimes, however, staph comes in contact with us and can cause an infection.

The most common scenario is when there is a break in the skin, which is your first line of defense in any infection, and bacteria get into that site and multiply. Examples of this would be a bug bite that is scratched and as you drag your nails across your skin, you irritate the bite, open the skin layer and expose the raw area to whatever you are carrying under your nails. Another frequent infection is impetigo under the nose after a child has had several days of runny nose. The area becomes raw from the frequent wiping causing small breaks in the skins surface and the staph living in the nares and on the skin move into the site and cause infection. In addition to infected bites and impetigo, staph can cause boils/abscesses requiring drainage, infections in the blood stream, styes, folliculitis, and even more serious infections such as Toxic Shock Syndrome and Staph Scalded Skin Syndrome.

Through time, some bacteria have become more intelligent thus resistant to our standard antibiotics. The over-prescribing of antibiotics for non-bacterial infections and incomplete courses of antibiotics has enabled bacteria to change their surfaces to tolerate those antibiotics and not be killed by them. With that said, many of today's illnesses and infections become difficult to treat because the bacteria out there have learned to adapt to the antibiotics we prescribe and in turn not be effectively treated. Some Staph infections have evolved into almost “superbugs” that are becoming increasingly difficult to treat. MRSA (Methicillin Resistant Staph Aureus) has made headlines first in the medical journals and now across all media. That name implies an infection caused by Staph Aureus that has now become resistant to Methicillin, a penicillin type antibiotic. So how does all this apply to Johnny, our star quarterback?

The common scenario in high school, or other groups, is that one person gets an infected hair follicle (or pimple or bug bite) and he/she shares the same weight bench with the next kid and then the organism gets passed. That difficult-to-treat bacteria then finds its home on the new host that then shares a practice uniform with a friend who forgot to bring theirs. Then tiny infected bumps develop into larger boils or abscesses that require drainage and longer courses of stronger antibiotics.

In the sports setting we see our young athletes sharing equipment such as football pads and helmets, weight lifting benches and sometimes uniforms. Players often share towels while lifting weights or after showers increasing the risk of passing more resistant organisms from player to player. To cut down on these rapidly spreading outbreaks we need to encourage our athletes to take certain precautions. First, if a player has any suspicious lesions (red, painful, draining) they should see their physician. Second, all weight benches and equipment should be wiped down with an antibacterial spray/wipe between uses. Third, all towels should be single use towels, not shared among players. All players should shower with antibacterial soap as quickly as possible after workouts and keep their nails trimmed short.

Treatment for these infections can range from a topical antibiotic to more commonly an oral antibiotic or, in more severe cases, IV antibiotics. If there is a collection of pus in the lesion, many physicians will clean and open the site to send a culture. Sending a culture allows your doctor to know precisely what organism is growing and which antibiotic will most effectively treat it. Often we will prescribe hibiclens baths (antibacterial) or bleach baths to eradicate the harmful bacteria from the skins surface. We also will often have carriers use an antibacterial ointment in their nares to cut down on passing it to others. Covering an infected area will also cut down on its potential spread to others. If infections persist or become increasingly difficult to treat, an infectious disease specialist may be asked to help.

Ashli N. Collins, M.D. is a pediatrician with Oldham County Pediatrics with offices in LaGrange and Louisville. She is married to Paul Loheide, M.D. and they have twins, Sarah and P.J. She enjoys running, swimming, cycling and sewing.