Question: My husband has had a staph infection for six years now. He gets boils on the back of his neck and there is at least one there all of the time. He has been to doctors and they tell him the treatment would be worse than just living with it. Do you have any suggestions on how to get rid of this?
Dr. Hibberd's Answer:
Staphylococcus aureus (staph) is a skin surface dwelling bacteria that lives on the skin surface of most all of us and usually does not invade the skin surface absent some underlying condition or break in the integrity of or skin surface.
Culture swabs done on our skin whether ill or not will invariably grow out staph.
Some strains, however, are particularly hardy and do manage to invade the skin surface usually via minor sites of irritation, cuts or via infection of the sebaceous gland associated with the hair follicle.
The past 10 years have seen an increasingly resistant strain of this bacterium emerge called MRSA (which stands for methicillin resistant sphylococcus areus). MRSA is resistant to the conventional antibiotics used to treat usual staph infections, is notoriously infectious, has a tendancy to cause deep abscesses, and is very difficult to eradicate once contacted.
Risk factors for MRSA are as follows:
•Antibiotic use in the past year
•Long-term care, nursing home, or hospital residency
•Presence of permanent indwelling catheter or percutaneous medical device
•Recent hospitalization
•Exposure to athletic facilities or correctional facilities
•Patients who are immunocompromised
•Military training and/or deployment
•Poor hand hygiene in both health care and community environments
•Crowded living conditions
A carrier state for MRSA exists in the nose for most of its victims, requiring extended treatment with topical bactroban in addition to oral antibiotics to clear up infections.
Usually oral Bactrim is used, often in association with topical and intranasal bactroban and rifampin for resistant or recurrent cases.
Intravenous preparations such as Vancomycin (a toxic antibiotic) are available but have significant adverse effects limiting their use to severe life-threatening infections. Oral vancomycin is not useful here due to lack of absorption.
A new class of antibiotic has recently become available for intravenous use in severe complicated and intra-abdominal infections. Called glycylcyclines, they are related to tetracylcines and the first one available is tigecycline (marketed as Tygacil). This new antibiotic has good MRSA coverage, at least for now until resistance develops, and is for severe infections only.
I recommend you have these abscesses properly treated first and be sure to obtain a stain culture and sensitivity of the contents of one of these boils, so you understand which anti-microbial agents are going to be the most useful.
You need to differentiate whether MRSA or some other organism (such as pseudomonas or other pathogens) are responsible. Proper treatment may involve oral and/or topical antibiotic use, selective drainage of abscesses, and meticulous hand hygiene.
Be sure to treat any underlying conditions (such as diabetes mellitus, immune deficiency, chronic dermatitis, nutritional and hygiene issues) that may predispose you to infection.
Avoid tight fitting collars until well healed.
Staph is usually the culprit and is spread by direct contact, so frequent hand washing with anti-bacterial soap will be essential. Minimize recurrences with measures described above and your doctor may consider periodic use of an antiseptic solution or rinse such as hibiclens to intact skin surfaces to reduce your staph load. I agree this skin condition can and should be controlled. Request a referral to a dermatologist if you wish an alternate professional opinion.
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