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November 21, 2007 > A Bug That's Harder to Kill

A Bug That's Harder to Kill

Pediatric Patients Among Those at Greatest Risk for Serious Staph Infection

The Staphylococcus family of bacteria and the infections these common bacteria cause are nothing new, according to Dr. Tim Nicholls, a pediatric hospitalist at Washington Hospital. In fact, as many as a quarter to one-third of all people carry these bacteria in their nose and throat without developing an active infection. But certain populations - such as newborn infants - are at greater risk if exposed.
There are more than 30 different types of bacterium in the Staphylococci family that can infect humans, but most infections are caused by Staphylococcus aureus.
"Staph infections are a common ailment in both adults and kids," Dr. Nicholls explains. "It's when staph gets into areas that are typically free of bacteria, such as the lungs or bloodstream, that it can cause a greater problem."
A common infection that can become serious
Skin infections caused by staph bacteria are the most common and typically cause the affected area to become bright red, warm to the touch and painful, according to Nicholls. In most cases involving young children, the infection is easy to spot because kids have little problem making their discomfort known.
However, if left untreated, staph infections of the skin can progress into a variety of more serious ailments, such as impetigo or cellulitis. In rare instances, a condition called scalded skin syndrome may develop in which the staph bacteria produces a specific protein that loosens the connective elements holding the various layers of the skin together allowing a blister formation and potentially deadly sloughing of the top layer of skin.
For a number of reasons, staph infections have become potentially more dangerous in recent years, according to Dr. Nicholls, due to an increasing prevalence of antibiotic-resistant strains of the bacteria. Known as MRSA, Methicillin-resistant Staphylococcus aureus infection is an infection with a strain of Staphylococcus aureus bacteria that is resistant to certain antibiotics, including methicillin, amoxicillin, and penicillin.
"The resistance to commonly prescribed antibiotics has become rather typical," Dr. Nicholls says. "Less than 20 percent of infections were resistant to antibiotics in hospital cases during the early 90s. Now the percentages are much greater and that's concerning, especially if the resistance is associated with increasingly invasive bugs. In the Bay Area, for all staph infections, it's close to 50 percent or more that are considered MRSA. ER doctors across the Bay Area see staph infections all the time, and these days, everyone has changed their antibiotic practices in response to these resistant strains."
Some strains of staph bacteria, Dr. Nicholls says, are also more invasive, meaning they are able to more easily break through the skin barrier. Thus, any break in the skin can potentially leave a person susceptible to a staph infection.
Those at greatest risk
In the pediatric population, newborn infants are among those at greatest risk for a dangerous infection caused by staph bacteria.
"A big concern is for newborns and small infants with immature immune systems," Dr. Nicholls notes. "For family members of children in this age group, frequent hand washing and overall hand hygiene practices are vital because this is the age group that doesn't fight the infections well."
Because staph infection spreads through person-to-person contact, it tends to circulate through households, making hand hygiene particularly important for those with young infants at home.
However, Dr. Nicholls is quick to point out that staph infections, unlike illnesses like chicken pox, are not airborne and do not spread throughout places like a classroom without close personal contact.
"Just the fact that you or your child has met and had contact with someone with the bacterium doesn't mean you will develop an infection," he says.
Another less obvious segment of the pediatric population at risk for acquiring a potentially dangerous staph-related infection is older children and teenagers who play contact sports, according to Dr. Nicholls.
"In addition to trends within single households, we also see clusters among children who have common skin abrasions, such as football players who share their pads and among wrestlers as well," he says. "Kids who play team sports are used to bruises and bumps and may not be as mindful of their bodies as adults are, and therefore are less likely to notice something wrong."
If not their parents, Dr. Nicholls says teens should be aware to approach someone they trust, such as a teacher, coach or doctor to help them make a judgment about seeking medical care if they notice anything unusual about a skin abrasion.
Make a good habit out of hand washing
While there is no way to completely eliminate the risk of staph infection, hand washing and cleaning household surfaces with a bleach solution can go a long way in reducing the likelihood of infection spreading, according to Dr. Nicholls.
Good hand-washing practices in the hospital setting have been shown to reduce the likelihood of spreading the infection, which is why many public health departments in the Bay Area have been encouraging use of anti-bacterial liquids and proper hand-washing techniques.
In an effort to help lower the rate of hospital-acquired MRSA infections, Washington Hospital has become the first hospital in the Bay Area to use a new MRSA testing procedure that can produce results in less than 2 hours. Until recently, MRSA testing could take up to two to three days. By being able to identify an infected patient in a short amount of time, hospital staff members can now rapidly intervene and decrease the opportunity for MRSA transmissions.
When it comes to staph infections, Dr. Nicholls offers one last crucial piece of advice to parents of young children: "Getting medical attention earlier rather than later can be life-saving."
Washington Hospital's Pediatric Hospitalist Program was implemented to ensure children treated in the hospital receive the highest level of care. To learn more about services and programs at the hospital, visit and click on "Services & Programs."

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