Box 124 MRSA and a Beauty Salon

In late 2004, a beautician in Holland experienced recurring infection with MRSA that required surgical drainage. After antibiotic treatment, she was declared MRSA-free (December 2005), but 3 months later, she tested positive for colonization. An epidemiologic study was performed that included 45 persons she contacted between July 2005 and December 2006. Fifteen persons had skin infections, and 10 of these individuals were colonized with MRSA. Overall, 11 persons were MRSA-positive, each with the USA300 strain. Two salon customers had skin lesions caused by MRSA; one was hospitalized. Waxing to remove unwanted hair was suspected as a route of bacterial transmission, but screening of 19 regular customers, employees, and waxing implements was negative.258 Thus, waxing may not contribute frequently to transmission of MRSA.

When a person is infected with MRSA, infections can recur, probably from bacterial colonization of the patient's body. (Persons with hospital infections are often colonized by MRSA before the infection.) Common sites of colonization are the nose, mouth, and other body openings. Decolonization regimens sometimes help stop outbreaks, both in hospitals and in community settings. In addition to frequent bathing, antibacterial agents, such as chlorhexidine, are added to soap. The antibiotic mupirocin has been effective at decolonizing healthcare workers; however, recolonization is common. Consequently, routine antibiotic treatment is not recommended due to the risk of creating resistant colonization. Avoiding contact with large animals may be prudent: Horses are sometimes colonized with MRSA. (Large-animal veterinarians have a higher frequency of MRSA colonization than the general public.)259 Companion animals (dogs) are reported to carry the same MRSA strain as veterinary staff.260 Thus, treating a companion animal with antibiotics could, in principle, lead to the emergence of antibiotic-resistant bacteria that transfer to handlers.

Certain persons should be particularly alert for MRSA infection. Among the more obvious are members of a family experiencing recurring infection. Persons engaging in skin-to-skin contact (athletes) or living in crowded conditions (prison inmates, child-care attendees, military recruits) also have elevated risk. So do healthy newborn infants when the mother has a history of S. aureus infection. Farmers and food handlers constitute a new category of at-risk persons, because MRSA has entered the food supply chain (see Box 12-5).

Several other groups found to be at risk are children, young adults, native Americans, African Americans, and Pacific Islanders. Persons who are overweight need to take special care if folds of skin create moist regions.

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