MRSA colonization question

[gr8rnpjt, RN]

My daughter lives in California. Before her husband was deployed, they came to hometo visit. They stayed with his mother and his younger brother. The day before they left, his younger brother was admitted with MRSA pneumonia. Apparently his entire lung was filled with opacity, and they considered a chest tube. He was hospitalized for 2 weeks.

They went back to California, and my SIL was deployed to Iraq. Then, about 4-6 weeks later, my DD called me and described her legs as having white dots at the bottom of each hair shaft on her legs. I explained it sounds like folliculitis, you need an antibiotic, call your doctor. They dr saw her, put her on a broad spectrum antibiotic, cultured the drainage from a couple of follicles. 1 week later, She called me panicked. She had large abscesses in her groin, a couple were open and draining, the others were hard red swollen. I insisted she call her MD back and request culture results.

And, yes, 5 minutes later she called me back and said they told her the cx was + for MRSA. Now, they had the culture results in the office for who knows how long and they had not planned on calling her back about the dx?

They switched her to another po antibiotic (one I haven't heard of) and the abscesses did go away.

Until about 3 days ago. she has 2 new abscesses on her lower back. One open and draining, the other hard and swollen and painful. I have been trying for 2 days for her to go back to the doctor for another culture. She refuses. She thinks they are both bug bites. I am going nuts. What are the chances she still has the MRSA? She does not seem to want to face the fact that she might still have it.

Any ideas?

[Gompers, BSN, RN]

I have some friends who frequently get those abscesses. Every time, they are MRSA. They've been treated with antibiotics, but the abscesses always seem to come back. She needs to go back to her doctor.

[gr8rnpjt, RN]

That's what I keep telling her. But she is 24 and knows everything. Mom knows nothing. Thanks.

[ICRN2008, BSN, RN]

Maybe it's time to consult an infectious disease specialist if she does not feel that she is receiving adequate treatment by her primary care physician.

[Gompers, BSN, RN]

Maybe it's time to consult an infectious disease specialist if she does not feel that she is receiving adequate treatment by her primary care physician.

That's a great idea!

[gr8rnpjt, RN]

Apparently the military physicians assigned to them are not very progressive when it comes to referring to a specialist. Missy insists that it is hard enough to get an appointment with her PCP. She says her only option is going to the ER and she does not feel that is an option for her. She just started a job as a nanny for a pilot and a PA. She is able to bring her 10 month old with her to their house and watches their 7 month old baby and 2 older boys aged 5 and 7. She won't listen to me, she says she cannot take all these kids to the ER, and does not want to tell the parents. I said the PA works in an orthopedic surgeons office, I know she knows what MRSA is and she will agree this is something that cannot be ignored. Missy does not want to be fired. I know she knows how to practice good handwashing technique and she keeps them covered and does not mess with them till she gets home. But with her long hours, that is not paying proper attention to the wounds. I am worried about her and there is nothing I can do. I insisted last night that she tell the parents about the possibility she may be infected and colonized with MRSA.

[LIZPICURN]

I hope your daughter will change her mind. It is good she has you for encouragement and support. If left untreated MRSA can infact be deadly. This is nothing to take lightly. Please remind her this. Her boss, a PA, will be educated enough to understand and not "fire" her. Good luck.

[VickyRN, MSN, DNP, RN]

We have been using a relatively new medication, Linezolid, for certain MRSA infections. This can be given either IV or PO.

http://infectious-diseases.jwatch.org/cgi/content/full/2002/621/1

http://www.findarticles.com/p/articles/mi_hb077/is_200210/ai_n5977537

As always, we at allnurses cannot give medical advice. I echo BSNDec06 - Please urge your daughter to see an infectious disease specialist ASAP, especially since she is handling young children.

[kids]

Here are some CDC fact sheets on Community Associated MRSA that may answer some of your questions and may also be something you want to pass on to your daughter.

For the public: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html

For clinicians: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_clinicians.html

[gr8rnpjt, RN]

Thank you to all who responded. I printed info from links provided and will send to my daughter. She has made an appointment with her PCP and she plans to make sure they do something so that it does not keep coming back. DD is well aware now of how easily it can be transmitted and is afraid for the children. I was also able to convince her to tell her employer who is very agreeable to DD getting treatment.